Minnesota Department of Health
Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting
September 11, 2012
1:00 p.m. – 4:00 p.m.
September11,2012AdvisoryPanelMeetingAgenda
Time Agenda Item 1:00 PM Welcome & Introductions Presenters Bruce Alexander Description/expected outcome Panel members & audience are invited to introduce themselves Preparation for the Legislative Report Background for discussion of EHTB successes & recommendations to the legislature 1:05 PM 1:20 PM 1:40 PM 2:00 2:10 3:15 Brief review of EHTB accomplishments Ongoing mercury biomonitoring; aims and recommendations Ongoing PFC biomonitoring recommendations Refreshments The 2012‐2013 Report to the Legislature PFC Presentation: Update on C8 Probable Link Reports Barbara Murdock Jessica Nelson Jean Johnson Jean Johnson Jessica Nelson Bruce Alexander Jessica Nelson This review provides background for the discussion of recommendations to the legislature and key accomplishments. Discussion Item Panel members are invited to comment on the proposed Specific Aims. In‐depth discussion of recommendations is scheduled under the legislative report section (below). Discussion item Panel members are invited to comment on ongoing PFC biomonitoring. In‐depth discussion is scheduled under the legislative report section (below). Decision Item  What program accomplishments should be highlighted in the report?  What recommendations to the legislature should be included in the report for ongoing Tracking and Biomonitoring in MN? Discussion item: Members are asked to consider these questions:  Are these talking points and Q&As appropriate and complete?  Do panel members suggest any changes or additions to the talking points? 3:30 3:35 3:40 3:50 3:55 4:00 Biomonitoring updates  Mercury in newborns  Great Lakes  National Initiatives Tracking Updates  Population characteristics  Blood Lead  Obesity & tobacco use  COPD map  Reproductive outcomes/birth defects Legislative Update New Business Questions or comments from the audience Motion to adjourn Aggie Leitheiser Bruce Alexander Bruce Alexander Bruce Alexander Information Items. Panel members are invited to ask questions and comment on the content. Information Item. Panel members are invited to ask questions and comment on the material. Panel members are invited to ask questions and comment on the initiative. Request for new topics for future discussion Invitation for audience members to ask questions or make brief comments Request for a motion to adjourn Note to audience: The panel asks that audience members hold their comments and questions during each discussion item until the end of the panel’s discussion, when the panel chair will invite questions from the audience. Audience members are asked to identify themselves when they speak, and to please put their names and affiliations on the list at the sign‐in table. Meetings are recorded on audiotape. 2
TableofContents
September 11, 2012 Advisory Panel Meeting Agenda ................................................... 1 Section Overview: A Review of Biomonitoring Achievements ...................................... 5 Achievements of the EHTB Tracking and Biomonitoring Program ............................................. 7 Section Overview: Ongoing Mercury Biomonitoring in Minnesota .............................. 9 Ongoing Mercury Biomonitoring in Minnesota & Proposed Specific Aims (Part 2) ................. 11 SPECIFIC AIMS: Part 2, Response to Motion 2 ......................................................................... 13 Section Overview: Future PFC Biomonitoring in Minnesota ....................................... 17 Future PFC biomonitoring in MN .............................................................................................. 19 Section Overview: The 2013 Legislative Report .......................................................... 21 The 2013 Legislative Report ...................................................................................................... 23 Section Overview: PFCs: Update on C8 Probable Link Reports ................................... 27 Update on C8 Probable Link Reports ........................................................................................ 29 MDH Talking Points for Media Questions ................................................................................. 33 Section Overview: Biomonitoring Updates ................................................................. 35 Section Overview: Tracking Updates .......................................................................... 39 Section Overview: Other Information ......................................................................... 45 Summary: June 12, 2012 Meeting of the EHTB Advisory Panel ................................................ 47 2012‐2013 Meeting Schedule ................................................................................................... 61 Environmental Health Tracking and Biomonitoring Advisory Panel Roster ............................. 62 Biographical Sketches of Advisory Panel Members .................................................................. 65 Staff Biosketches ....................................................................................................................... 69 Environmental Health Tracking and Biomonitoring Statute ..................................................... 72 Laws of Minnesota 2011 First Special Session Chapter 2. ........................................................ 77 3
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SectionOverview:AReviewofBiomonitoringAchievements
EHTB staff will present a brief PowerPoint review of key achievements of the program. The presentation will provide background for the decisions to be addressed in the discussion about the legislative report. Bruce Alexander will lead the discussion about content and recommendations to be included in the EHTB program’s Report to the Legislature. Discussion Item Panel members are invited to comment on the program’s most significant achievements. During in‐depth discussion to follow, panel members are asked to provide specific recommendations to the Commissioner of Health regarding significant achievements and success stories that should be highlighted in the 2013 Report to the Legislature. 5
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AchievementsoftheEHTBTrackingandBiomonitoringProgram
Over the five years since the Minnesota legislature established the Environmental Health Tracking and Biomonitoring program in July 2007, MDH has made significant progress in fulfilling its legislative mandate to build and maintain a strong new state program for tracking environmental hazards, population exposures (biomonitoring), and related chronic diseases and health outcomes. MDH has planned and carried out four community‐based biomonitoring pilot projects, and two follow‐up projects. These projects have been highly successful in building state program capacity, informing and evaluating public health actions, identifying disparities, and in addressing community concerns about environmental exposures. MDH staff knowledge and experience, captured in a series of “lessons learned,” have been shared with other public health programs and states interested in biomonitoring and contributed to developing national guidance documents for public health biomonitoring. Working with key stakeholders and the Advisory Panel, staff have conducted strategic planning for an ongoing state biomonitoring program and identified effective biomonitoring population exposure tracking strategies for Minnesota, identified key target populations, and developed Minnesota‐appropriate criteria for choosing priority chemicals for biomonitoring study. Below is a short list of EHTB program accomplishments and benefits to MN. Over the course of the development of the EHTB program, MDH accomplished the following: 
Investigated public concern about PFC exposure from drinking water in the East Metro. A follow‐up study showed that public health actions were effective at reducing exposure in the community. 
Identified a disturbing potential public health problem―10% prevalence of unhealthy mercury exposures among Minnesota newborns in the Lake Superior Basin. Data will inform efforts to strengthen actions aimed at mercury exposure prevention. 
Identified diet as a primary source of children’s arsenic exposure in Minneapolis through speciation and found no association with soil contamination; provided assurance to parents in the community. 
Documented income and racial disparities in BPA and paraben exposures among pregnant women at Minneapolis‐Riverside clinic. Most BPA exposures were below US average levels. 
Cotinine measurements indicated that 14% of pregnant women tested were active smokers, comparable to the 13.8% self‐reported smokers in the MN Pregnancy Risk Assessment Monitoring Survey. 7

Advanced MDH Public Health Laboratory capacity to measure PFCs, arsenic, BPA and parabens in human specimens and to develop novel methods to test newborn exposures to mercury, including heel stick spots and umbilical cord blood. 
Built state environmental epidemiology capacity for the collection, integration, and analysis of drinking water, air quality, and chronic disease data in Minnesota to examine trends and relationships. 
Successfully leveraged Minnesota’s investment in the EHTB program by attracting federal funding to join the CDC Environmental Public Health Tracking Network of 23 states. CDC currently funds the Minnesota Public Health Data Access portal for broad dissemination of tracking data and interactive maps. 
Successfully added collaborative biomonitoring pilot projects to federally funded MDH and University of Minnesota projects, thereby further leveraging Minnesota’s support for the EHTB program. 8
SectionOverview:OngoingMercuryBiomonitoringinMinnesota The MDH Mercury in Newborns in the Lake Superior Basin biomonitoring pilot study measured total mercury in residual newborn blood spots collected from 1,465 infants born to mothers in the US Lake Superior Basin (MN, WI, MI; 2008‐11). The findings suggest that up to 10% of babies in the Lake Superior Basin―and perhaps in other regions of Minnesota―may be exposed during gestation to mercury levels that can harm cognitive development. A seasonal pattern in higher exposures suggests that local fish consumption may be a strong contributing factor in this region, particularly in the summer. An important public health question is whether this observation is unique to babies in the Lake Superior region of the state or whether these patterns can be observed in other parts of the state. In response to these findings, the EHTB Advisory Panel passed two motions. The first recommended a follow up study to compare mercury levels in cord blood to mercury in newborn spots to verify whether newborn blood spots accurately reflect mercury levels in cord blood and to enable the laboratory to identify the species of mercury. The second recommended that EHTB staff develop specific aims for ongoing work to characterize mercury exposure in broader regions of Minnesota. Jean Johnson will present a set of draft specific aims for ongoing biomonitoring in Minnesota that would measure the sources and extent of mercury exposure in newborns in Minnesota, enable the laboratory to refine methods for measuring mercury in newborns, and strengthen support for public health programs that reduce mercury exposure in newborns. Discussion Item. Panel members are invited to comment on the proposed Specific Aims. During in‐depth discussion to follow, panel members are asked to provide specific recommendations to the Commissioner of Health regarding ongoing biomonitoring of mercury in newborns or in other target populations. Recommendations will be included in the 2013 Report to the Legislature as part of recommendations for an ongoing biomonitoring program. Question to the panel:  Do you recommend any changes to the proposed specific aims, rationale, and significance described here?  Should EHTB staff develop a set of strategies and methods for ongoing biomonitoring to achieve these specific aims? 9
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OngoingMercuryBiomonitoringinMinnesota&ProposedSpecific
Aims(Part2)
Background
The MDH Mercury in Newborns in the Lake Superior Basin biomonitoring project measured total mercury in residual newborn blood spots collected from 1,465 infants born to mothers in the US Lake Superior Basin (MN, WI, MI; 2008‐10). The project was funded by the EPA and the State of Minnesota Environmental Public Health Tracking and Biomonitoring (EHTB) program, and served as one of the legislatively‐mandated EHTB pilot projects for monitoring mercury levels in an exposed community. Results of the project were reported to the EPA in November 2011 and to the EHTB Advisory Panel in December 2011. The EHTB goals of the original study were to:  Characterize exposure in a population of newborns in the Lake Superior Basin.  Assess the feasibility and validity of a novel method that uses newborn blood spots for mercury biomonitoring.  Assess the need for further biomonitoring in this population or other populations in the state. All specimens were obtained in collaboration with newborn screening programs in the three states. In Minnesota, mothers were contacted after the births to obtain written informed consent for the testing. All blood specimens that were sufficient for analysis were anonymized before testing by the MDH Public Health Laboratory for this study. Most infants were from Minnesota (n=1,126). Results of the study revealed that 10% of the Minnesota spots tested (n= 1,126 newborns born during the study period between November 2008 and May 2011) had total mercury concentrations >5.8 µg/L, the level in umbilical cord blood corresponding to the EPA reference dose (RfD) for methylmercury. The reference dose represents a daily oral exposure likely to be without adverse effects over a lifetime. Fourteen newborns had mercury levels above the benchmark dose limit (>58 µg/L), the lower 95% confidence limit of the dose that is estimated to result in a 5% increase in abnormal scores on a sensitive test of neurological function.1 Average mercury concentrations in the Minnesota newborn blood spots were higher in summer, which suggests that the mothers may have been exposed by eating fish from local lakes. This in turn implies that the chemical form may be primarily methylmercury, rather than inorganic mercury. However, the form of mercury measured in the blood spots is unknown because the quantity of residual blood in the specimens was insufficient to allow the laboratory to conduct speciation, and no method for speciation of blood spots has been developed. 1
National Research Council, Committee on the Toxicological Effects of Methylmercury, Board on Environmental Studies and Toxicology. Toxicological Effects of Methylmercury, National Academy of Sciences: Washington DC; 2000 11
Methylmercury, a potent neurotoxin, is readily taken up by the brain and nervous system in rapidly developing fetuses and young children. Health effects include delayed cognitive and behavioral development. Inorganic mercury and vapor from metallic mercury can affect the gastrointestinal tract, kidneys, and nervous system. Health effects vary according to the exposure level. Advisory Panel Recommends Next Steps In the December 2011 Advisory Panel meeting, results from the project were presented to the EHTB Advisory Panel, and members discussed next steps. Advisory Panel members commented on key questions that remain for interpreting these results, including the following: 


The relationship between mercury levels measured in newborn blood spots and cord blood is unknown. This information is needed so we know whether comparison to the EPA reference level (based on cord blood) is valid for interpreting the findings and their implications for public health. Speciation is important and would help in identifying the sources of the exposure. High levels in the tail of the distribution, in particular, might reflect other sources of mercury exposure. It would be useful to compare these results with a different MN population to see if it’s a state problem or is unique to the Lake Superior region, and to identify whether the seasonal peak in exposure is related to local or regional exposure differences. EHTB Advisory Panel members agreed that this pilot project’s results raise important public health questions that merit further investigation. The panel requested that staff develop specific aims and proposals for future work on these questions and bring them back to the panel for further review. The panel passed two motions: Motion 1 (passed) Do a follow‐up study that would compare mercury levels in cord blood to mercury in newborn blood spots. The study would use paired samples of cord and newborn blood spots from each newborn in the study. The study would verify whether newborn blood spots accurately reflect the mercury levels in cord blood and enable the laboratory to identify the species of mercury. Motion 2 (passed) Down the road, the EHTB program should look for resources to investigate the sources of mercury exposure in other populations in the state. The long‐term objectives are to develop other [methods] to characterize exposure in broader populations of Minnesota to learn the [sources and] extent of the problem [identified in the Lake Superior pilot project]. 12
SPECIFICAIMS:Part2,ResponsetoMotion2
Project to Measure the Sources & Extent of Mercury Exposure to Newborns in MN Goals, Rationale, and Significance (Proposed) Goal 1: Measure the distribution, geographic and temporal patterns of total mercury in a population‐based, representative sample of newborns in Minnesota; to provide a reference or baseline for ongoing surveillance of exposure in at‐risk sub‐populations in the state. Goal 2: Learn whether subpopulations in the state have the same (or different) prevalence of babies born with elevated mercury concentrations (exceeding the EPA reference limit) as those observed in the Lake Superior newborns pilot project; to learn how widespread the problem of elevated mercury in newborns might be and which subgroups are most likely to be impacted. Goal 3: Measure the extent to which maternal factors (e.g., age, income, education, race/ethnicity) and source contributions (e.g., fish consumption, dental amalgams, mercury‐containing products) explain variations in the total and speciated mercury concentrations in newborns. Goal 4: Refine MDH laboratory methods for measuring mercury exposure in newborns. Laboratory staff have suggested improvements to the laboratory method for analyzing newborn blood spots. One would improve understanding of the extraction efficiency of the inorganic and organic forms of mercury from dried blood spots. A better understanding of the different chemical forms of mercury could lead to an overall improvement in method extraction efficiency and improved standard recoveries; the current method’s standard recovery is about 80%. Goal 5: Inform and strengthen support for public health programs, actions and interventions so that resources are used wisely, and the prevalence of elevated exposure in Minnesota newborns (exceeding the reference limit) is reduced. Rationale Pilot study findings measuring exposure to newborns from newborn blood spots suggest that a significant proportion (up to 10%) of babies in the Lake Superior Basin and perhaps in other regions of Minnesota may be exposed during gestation to mercury levels that can harm cognitive development. A seasonal pattern was observed, which suggests that local fish consumption may be a strong contributing factor in this region, particularly in the summer months. An important public health question is whether this observation is unique to babies in the Lake Superior region of the state or whether these patterns can be observed in other parts of the state. Methyl mercury is likely to be the most significant form of the elevated exposure, and the source may not be limited to locally‐caught fish. Studies in urban populations, 13
including a study of children in a disadvantaged neighborhood in Minneapolis,2 have found elevated concentrations significantly above the US average and suggest that urban populations are also exposed, possibly through consumption of commercially‐
caught fish. In addition, the contribution of inorganic mercury sources to newborn exposure is unknown. A New York City biomonitoring study of mercury in adults identified inorganic mercury in skin‐lightening creams as a source,3 and some members of large subpopulations in Minnesota may use these products, despite state laws that ban them from store shelves. For identification of the source contribution, speciation of the mercury to distinguish the organic and inorganic forms is an important and necessary step in the laboratory analysis, since most methyl mercury is assumed to come from fish consumption. Further refinement of laboratory methods, including speciation, will result in greater reliability and validity of the data collected, and greater confidence in our interpretation and use of the data for public health decision making. In addition to speciation, a maternal questionnaire with information on demographic factors, dental amalgams, product use, and dietary exposure in pregnancy and other risk factors will further elucidate the contribution of multiple sources of the newborn exposures. With more data about sources and vulnerable subpopulations, more cost effective local and state public health actions can be tailored to address specific regional and population differences. The data will also inform studies needed to discover new, emerging risks or factors that predict under what conditions and locations these elevated exposures are likely to occur. Public Health Significance The prevalence of developmental disabilities in Minnesota is a growing concern among parents and increasingly costly for society and schools. In the US, the incidence of learning and developmental disabilities (LDDs) appears to be rising.4 A 2011 study5 assessed the prevalence of LDDs in children 3 to 17 years and found that nearly 10 million US children (~15%) in 2006‐08 had LDDs by parental report, about 1.8 million children more than 10 years earlier. In 1999‐2000, the special education costs of LDDs amounted to $77.3 billion/year, about $12,500/pupil, nearly twice the per student cost for regular students.6 The economic 2
Sexton K, et al. 2011. Biomarker measurements of concurrent exposure to multiple environmental chemicals and chemical classes in children. J. Tox. & Env Health, Part A, 74:927‐942. 3
McKelvey W et al., 2007. A Biomonitoring Study of Lead, Cadmium, and Mercury in the Blood of New York City Adults. Environmental Health Perspect. 115: 1435‐1441. 4
Scientific Consensus Statement on Environmental Agents Associated with Neurodevelopmental Disorders. Collaborative on Health and the Environment’s Learning and Developmental Disabilities Initiative, Nov 7, 2007. URL: http://www.neep.org/uploads/NEEPResources/id27/lddistatement.pdf 5
Boyle et al. 2011. Trends in the Prevalence of Developmental Disabilities in US Children, 1997‐2008. Pediatrics 127:1034‐1042. 6
Center for Special Education Finance. American Institutes for Research. Special Education Expenditure Project. No. 1: What Are We Spending on Special Education Services in the United States, 1999‐2000? (246 KB) — Updated June 2004. 14
costs of lead exposure above 10µg/dL in children estimated $6.94 billion ($10.76 billion in 2012 dollars) in medical care, compensatory education, and neonatal morbidity and mortality costs, plus an additional $5.06 billion in 1994 dollars ($7.84 billion in 2012 dollars) in lost earnings because of diminished intellectual capacity.7 The cost of mercury’s effects on cognitive development is similarly significant. A study8 of the cost of prenatal methylmercury exposure estimated that 5% of the children born in 2000 would be to women with higher mercury levels; eventually this prenatal exposure could cost the country $8.7 billion in 2000 dollars ($11.66 billion in 2012 dollars) in lost productivity. Improved monitoring of newborn exposure to mercury will yield data to guide and support decisions about maintaining, expanding, and targeting public health actions throughout the state. Public health actions would include local and state efforts aimed at keeping mercury out of the environment and statewide fish consumption advisories for pregnant women and women of child‐bearing age. Maternal and child health programs, immigrant health programs, clinicians and pediatricians will be better informed and able to advise women of child‐bearing age to avoid exposure sources. Ongoing biomonitoring of newborns will complement and expand upon current and proposed work in the Lake Superior region to screen women of child‐bearing age and improve educational interventions. The objective is to ensure that policy makers will be better informed so they can craft stronger public health policies and prevention efforts to protect Minnesota babies from the harmful developmental effects of mercury exposure during gestation. The ultimate goal is to move Minnesota and its communities towards “a healthy start for all.” As the Healthy Minnesota 2020 Statewide Health Plan notes, “a healthy start in life is critical for a life of good health and well‐being”. 7
Schwartz J. 1994. Societal benefits of reducing lead exposure. Environ. Res. 66: 105‐124. Trasande L, Landrigan PJ, Schechter C. 2005. Public health and economic consequences of methyl mercury toxicity to the developing brain. Env. Health Persp. 113(5): 590‐596. 8
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SectionOverview:FuturePFCBiomonitoringinMinnesota
MDH’s PFC biomonitoring pilot projects in the East Metro are nearing completion. The follow‐up project’s Phase 2 questionnaire analysis is underway and will be finished by June 2013. No further PFC biomonitoring projects are currently planned. But, in response to questions from the public and East Metro citizens, MDH staff developed a list of possible projects for consideration by the Advisory Panel. Discussion Item During in‐depth discussion to follow, panel members are asked to provide specific recommendations to the Commissioner of Health regarding ongoing biomonitoring of PFCs in the East Metro, or in other populations. Recommendations will be included in the 2013 Report to the Legislature as part of recommendations for an ongoing biomonitoring program. Questions for Advisory Panel  Should EHTB measure PFC levels in participants in the East Metro again?  Should EHTB measure PFCs in a different population in the East Metro or elsewhere in the state? 17
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FuturePFCbiomonitoringinMN
MDH’s PFC biomonitoring pilot projects in the East Metro are nearing completion: the follow‐up project’s Phase 2 questionnaire analysis is underway and will be finished by June 2013. No further PFC biomonitoring projects are currently planned. MDH staff developed the following list of possible projects for consideration by the Advisory Panel. Biomonitoring Project Pro Con East Metro follow‐up in  Ensure levels are decreasing &  We already know that same participants as past exposure reduction has been levels are dropping two projects effective  Sample size will continue to  Good participation likely; dwindle as participants are recruitment costs low lost to follow‐up and decline to participate  Add additional questions/data gathering if questionnaire analysis points to need for more information  Look at PFBA exposures before/after filter change  Serve as comparison group for current/ future biomonitoring studies (e.g., GLRI) MN reference  Establish MN baseline values  Unless combined with population: comparison biomonitoring for chemicals  Help interpret results from East population in another with known health effects Metro & other current/future part of Washington Co. or (e.g., mercury, lead), can’t biomonitoring study (e.g., GLRI) elsewhere in state say what results mean for  Allow investigation into PFHxS participants’ health exposure (not explained well by water exposure)to explore possible sources  Allow comparison of state background exposures to national data from NHANES  Gather information about sources of exposure in background‐exposed population Children or pregnant  Target population identified by  Unless combined with women (in East Metro biomonitoring for chemicals stakeholders as most important and/or another part of with known health effects and vulnerable state) (e.g., mercury, lead), can’t  Respond to community say what results mean for concerns about children’s health 19
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Occupational group: firefighters, ski waxers, plating shop workers, airplane mechanics 
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Vulnerable populations with 
higher risk of exposure Comparison results available for firefighters (CA biomonitoring program), ski waxers (Norway) Other comparison populations 
include 3M workers, NHANES 
Anglers: people who fish in contaminated pool of Mississippi 

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Potentially vulnerable population with higher risk of exposure May also capture a socioeconomically disadvantaged population Opportunity for sharing fish consumption advice 

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No further study 

The follow up study showed that 
public health action worked. Resources should be directed at 
other Minnesota problems participants’ health; providing some medical benefit even more of an ethical imperative in biomonitoring of children Limited national comparison data (pooled for children, no population sample for pregnant women as Natl Children’s Study not yet available) Unless combined with biomonitoring for chemicals with known health effects (e.g., mercury, lead), can’t say what results mean for participants’ health Identified by stakeholders as important target population, but not highest priority population No MN baseline data for comparison Unless combined with biomonitoring for chemicals with known health effects (e.g., mercury, lead), can’t say what results mean for participants’ health Identified by stakeholders as important target population, but not highest priority population No MN baseline data for comparison East Metro residents are still concerned The projects listed above have scientific merit. 20
SectionOverview:The2013LegislativeReport
This section presents an outline of the proposed 2013 EHTB Report to the Legislature, due January 15, 2013. Under the 2011 legislation, funding for the EHTB program was changed from an ongoing appropriation to a one‐time appropriation. This means that, without new legislative action to appropriate funding in the next session, the state EHTB program will end July 1, 2013. Bruce Alexander will facilitate a discussion about the proposed content and the advice the Advisory Panel will give staff in submitting specific recommendations for an ongoing program in the Report to the Legislature. The first two questions to the panel relate directly to the mercury and PFC presentations and questions discussed earlier. The other questions are intended to stimulate discussion. Panel members are invited to comment on the proposed outline and to make specific recommendations to the Commissioner of Health regarding content for the program Report to the Legislature in January 2013. Decision Item What content does the Advisory Panel recommend for inclusion in the legislative report? Questions to the panel:  What are the most important accomplishments of the EHTB program that should be highlighted in the Legislative Report?  Does the Advisory Panel recommend that EHTB move ahead with planning for an ongoing tracking and biomonitoring program for Minnesota?  If so, does the Advisory Panel recommend that EHTB develop plans for ongoing mercury biomonitoring of newborns as described in the Specific Aims?  If so, does the Advisory Panel recommend that EHTB measure PFC levels in participants in the East Metro again? Or a different population in the East Metro? In Minnesota?  Stakeholders have recommended a focus on children (as young as possible), pregnant women, and disadvantaged populations as target populations. o Does the Advisory Panel recommend that EHTB target children or pregnant women from any specific Minnesota populations? o Does the Advisory Panel recommend specific analytes of concern in addition to mercury (or PFCs) for future biomonitoring?  Does the Advisory Panel recommend that the EHTB program address other ideas or urgent areas of environmental public health concern in Minnesota? 21
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The2013LegislativeReport
EnvironmentalHealthTrackingandBiomonitoring
January2013ReporttotheLegislature
DRAFTOUTLINE
August2012
I.
Introduction Summarize EHTB‐biomonitoring and tracking accomplishments and benefits to MN for activities 
Investigated public concern about PFC exposure from drinking water in the East Metro; follow‐up study showed that public health actions were effective at reducing exposure in the community. 
Identified a potential public health problem―10% prevalence of unhealthy Hg exposures in group of tested Minnesota newborns in the Lake Superior Basin—follow up recommended. 
Identified diet as most likely source of children’s arsenic exposure in Minneapolis; reassured the community concerned about soil. 
Documented income and racial disparities in BPA and paraben exposures among pregnant women at Minneapolis clinic; most BPA exposures were below US average levels. Cotinine measurements indicated that 14% of the women were active smokers, comparable to self‐report in statewide survey. 
Advanced MDH public health laboratory capacity to measure PFCs, speciated arsenic, BPA, and parabens in human specimens; developed novel methods to test newborn exposures to Hg, including heel stick spots and umbilical cord blood. 
Built state environmental epidemiology capacity for the collection, integration, and analysis of drinking water, air quality, and chronic disease data. 
Successfully leveraged Minnesota’s investments in the EHTB program by obtaining federal funding to join the CDC Environmental Public Health Tracking Network of 23 states. This funding was used to enhance the work of the EHTB program and to improve service to the citizens of Minnesota. 23
II.
Progress Report for work in July 2011‐ June 2013 a. PFC Biomonitoring Pilot Project and Follow‐up a. Results and Current status b. Recommendations for continued PFC biomonitoring in 2013‐14 b. Mercury Biomonitoring Pilot Project and Follow‐up a. Results and Current status b. Recommendations for continued mercury biomonitoring in 2013‐14 c. Advisory Panel III.
Recommendations for an Ongoing Biomonitoring Program: Protecting Future Generations a. Strategic planning; input from stakeholders (what we heard) b. Looking ahead: examples of concerns for Minnesota’s children 1. Rising mercury levels in Minnesota lake fish 2. Lead exposure and older housing (CDC no longer funds MDH’s blood lead surveillance program in small children) 3. Manganese in well water, an essential trace nutrient and a neurotoxic metal. 4. Air pollution/traffic exposure 5. Racial and ethnic disparities c. Tracking exposure; children and vulnerable populations (what we recommend) d. Brief review of children’s and prenatal vulnerability (rationale; why we recommend it) e. How biomonitoring & tracking can help protect future generations (how it works) IV.
Environmental Public Health Tracking Progress Report a. Short Review of Minnesota’s Environmental Public Health Tracking Program (update & highlight progress). b. The hazard  exposure  health effect paradigm c. What we track d. Data linkages e. Responding to community needs f. Show integration of biomonitoring into EPHT program & portal. Portal Maps  24
Appendix A: Environmental Health Tracking and Biomonitoring Advisory Panel (roster) Appendix B: EHTB Legislation (2007; 2009, 2011 amendments and funding levels) Proposed Schedule for Drafting the Legislative Report  August 29–September 6‐7: begin drafting the report  Sept 24—Oct 18: continue drafting  Oct 18—24: first internal review  Oct 25—31 revise draft in response to first internal review  Nov 1—7: send revised draft legislative report to Advisory Panel  Nov 7—12: revise draft in light of Advisory Panel comments  Nov 13: send revised draft to EHTB Steering Committee members  Nov 20—Dec 12: revise draft in light of comments  Dec 13—18: near final draft to MDH Executive Office  Jan 3—10: last edits, formatting, and printing  Jan 14‐15: delivery to legislature. 25
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SectionOverview:PFCs:UpdateonC8ProbableLinkReports
C8 is the common name given to perfluorooctanoic acid, or PFOA. As part of the legal settlement of a case between plaintiffs and DuPont over PFOA contamination in West Virginia and Ohio, the C8 Health Project was established, which collected data from class members through questionnaires and blood testing. The project included almost 70,000 people. Biomonitoring in this large number of people found that average PFOA levels were higher when compared to the national average. The legal settlement also created the C8 Science Panel, composed of three epidemiologists who were chosen jointly by the parties to the legal settlement, to gather health information and to evaluate, in a series of reports for the court, whether there is a “probable link” between PFOA exposure and any human disease. More information can be found at: http://www.c8sciencepanel.org/index.html Over the past few years, the C8 Science Panel, has been studying possible health effects of being exposed to PFOA through drinking water contamination. Studies have focused on a number of health outcomes including heart disease, immune system function, liver function, hormone disorders, cancer, diabetes and birth outcomes. Thus far, the C8 panel has released several such reports about whether or not there is a “probable link” between exposure to PFOA and different diseases among the people in the lawsuit. Six new reports were released on July 30th. The last of these reports is expected to be released by October 31, 2012. Both the local media and the East Metro community are very interested in these findings. MDH staff are working proactively on how to respond to questions about our interpretation of the findings and the message to bring to the community. A summary of the report findings and general talking points are presented here for discussion. Discussion Item
After this presentation, panel members are invited to advise and comment on the question below. Questions for the Advisory Panel 


Given the report findings shown here, are these talking points and responses appropriate and complete? Do panel members suggest any changes or additions to the responses? Are there additional questions or concerns about these reports that staff should consider? 27
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UpdateonC8ProbableLinkReports
C8 Science Panel Findings Background Text extracted from Introduction of Probable Link reports (e.g. www.c8sciencepanel.org/pdfs/Probable_Link_C8_Autoimmune_Disease_30Jul2012.pdf): “In February 2005, the West Virginia Circuit Court approved a class action Settlement Agreement in a lawsuit about releases of a chemical known as C8, or PFOA, from DuPont's Washington Works facility located in Wood County, West Virginia. The Settlement Agreement had several parts. One part of the Settlement was the creation of a Science Panel, consisting of three epidemiologists, to conduct research in the community in order to evaluate whether there is a probable link between PFOA exposure and any human disease. A "probable link" in this setting is defined in the Settlement Agreement to mean that given the available scientific evidence, it is more likely than not that among class members a connection exists between PFOA exposure and a particular human disease. The Science Panel recognizes that, given the many diseases we are studying, some may appear to be associated with exposure simply through chance, but we have to judge these associations individually and acknowledge the uncertainty inherent in making these judgments. Another part of the Settlement established the C8 Health Project, which collected data from Class Members through questionnaires and blood testing. These data represent a portion of what the Science Panel evaluated to answer the question of whether a probable link exists between PFOA and human disease. Evidence comes from Science Panel research that has been published as well as Science Panel research that has not yet been published. In performing this work, the Science Panel was not limited to consideration of data relating only to Class Members, but examined all scientifically relevant data including, but not limited to, data relating to PFOA exposure among workers, among people in other communities, and other human exposure data, together with relevant animal and toxicological data…” 29
Text extracted from www.c8sciencepanel.org/panel_background.html: “Under the settlement agreement, the Science Panel is to deliver its finding to the parties once their analysis is complete. If the Science Panel finds no probable link to any human disease, DuPont's remaining obligations under the settlement agreement cease. If the Science Panel concludes that a probable link exists between exposure to PFOA and any diseases, DuPont will fund a medical monitoring program to pay for medical testing as designed by a separate, yet‐to‐be selected, independent Medical Panel.” Text extracted from www.c8sciencepanel.org/panel.html: “The panel is made up of: Dr. Tony Fletcher of the London School of Hygiene and Tropical Medicine, Dr. David Savitz of [Brown University], and Dr. Kyle Steenland of Emory University in Atlanta.” Probable Link reports as of August, 2012 Positive Probable Link reports: ulcerative colitis, thyroid disease, testicular and kidney cancer, preeclampsia and pregnancy‐induced hypertension Negative Probable Link reports: chronic obstructive pulmonary disease; asthma; childhood and adult infections such as influenza; neurodevelopmental disorders in children; stroke; five other autoimmune diseases (lupus, rheumatoid arthritis, Type 1 (juvenile) diabetes, Crohn’s disease, and multiple sclerosis); 19/21 cancers considered: bladder, brain, breast, cervical, colorectal, esophagus, leukemia, liver, lung, lymphoma, melanoma, oral (including larynx/pharynx), ovarian, pancreatic, prostate, soft tissue, stomach, thyroid, uterine; Type II diabetes; birth defects; miscarriage; stillbirth; preterm birth and low birth weight Probable Link reports to be released by Oct. 31: liver disease, kidney disease, Parkinson's disease, osteoarthritis, heart disease, hypercholesterolemia and hypertension 30
Summaries of positive Probable Link reports (Text extracted from Press page summaries: www.c8sciencepanel.org/press.html; links to full reports included) Ulcerative colitis www.c8sciencepanel.org/pdfs/Probable_Link_C8_Autoimmune_Disease_30Jul2012.pdf “Ulcerative colitis is a relatively rare disease characterized by chronic inflammation of the lining of the digestive tract. It causes chronic pain and discomfort, and generally cannot be cured. Ulcerative colitis is similar to, but not the same as, Crohn’s disease, another disease of the digestive tract. The evidence for the Panel with regard to ulcerative colitis comes from the study the Panel carried out of 32,000 Mid‐Ohio Valley residents and DuPont employees who were interviewed regarding their medical history. Medical records were obtained to validate self‐reported diagnoses. There were about 160 validated cases of ulcerative colitis considered by the Science Panel. Among these cases, there was a strong pattern of more disease occurring among those with higher PFOA exposure.” Thyroid disease www.c8sciencepanel.org/pdfs/Probable_Link_C8_Thyroid_30Jul2012.pdf “Thyroid disease is a common condition related to an imbalance in thyroid hormones. It can usually be well‐controlled by treatment with thyroid hormones. There were over 2000 validated cases of thyroid disease in the Science Panel study of Mid‐Ohio Valley residents. The Panel also analyzed data on thyroid hormones among Mid‐Ohio Valley residents and considered other reports in the scientific literature. While the evidence on thyroid disease was mixed, the Panel concluded overall it was more probable than not that C8 was linked to thyroid disease.” Testicular and kidney cancer www.c8sciencepanel.org/pdfs/Probable_Link_C8_Cancer_16April2012.pdf “One of the most important studies on which today's findings were based was a Science Panel follow‐up study of 32,000 people (28,000 community residents and 4,000 workers). Interviews with these 32,000 were conducted in 2009‐2011. Medical history was collected and the Science Panel sought medical records confirming any diseases reported. 3636 of these study subjects reported having had cancer classified into 21 different types in interviews carried out during 2009‐2011. Of these, the Science Panel was able 31
to validate 2420 (70%) diagnoses of primary cancer through medical record review and state cancer registry data… The Science Panel estimated the level of C8 in the blood of study subjects over time before cancer occurred, relying on records of past emissions from the DuPont plant and the residential history of study subjects. The Panel then determined whether those study participants who had higher levels of C8 in their blood over time had higher levels of cancer. The only two cancers where the Panel found a reasonably consistent and strong relationship between past exposure and cancer were testicular cancer and kidney cancer. Both these cancers are rare. In the Science Panel data there were 19 confirmed cases of testicular cancer and 113 confirmed cases of kidney cancer… A second Science Panel study which looked at cancer was a geographical study. Here the Panel looked at data from all registered cancers supplied by the Ohio and West Virginia Health Departments. They compared cancer rates in exposed areas in the Mid‐Ohio Valley versus other non‐exposed areas. The Panel found that areas with the highest rates of testicular cancer were the areas with the highest exposure. A similar but less consistent and less pronounced result was found for kidney cancer…” Preeclampsia and pregnancy‐induced hypertension www.c8sciencepanel.org/pdfs/Probable_Link_C8_PIH_5Dec2011.pdf (Text extracted from www.c8sciencepanel.org/prob_link.html) “Pregnancy‐induced hypertension is defined as significantly elevated blood pressure that begins after the 20th week of pregnancy. Preeclampsia is a specific type of pregnancy‐induced hypertension, which is accompanied by leakage of protein into the urine. The evidence to evaluate the probable link between PFOA exposure and pregnancy‐induced hypertension comes from various studies using data from the C8 Health Project (such as residential data, measured serum PFOA, and self‐reported pregnancy conditions), data from birth certificates, and historically estimated serum PFOA levels. While one study found no association between C8 and pregnancy‐induced hypertension, other studies showed a small association. There was also evidence of an association between estimated serum PFOA and pregnancy‐induced hypertension based on the continuous exposure indicator. Measured serum PFOA was weakly and irregularly associated with preeclampsia, an association that was strengthened when the analysis was restricted to more recent pregnancies.” 32
MDHTalkingPointsforMediaQuestions
Because the media and citizens in the East Metro are very interested in the reports from the C8 Health Project, MDH has done advance planning on how staff can respond to media questions. The talking points and answers to expected questions below were developed in collaboration with MDH Environmental Health Division and Communications Office staff in July 2012. MDH message  MDH is paying close attention to the Science Panel’s findings. We share the community’s concern about the possible human health effects of PFCs, and are working on understanding these and other new findings better. We will continue to communicate with the community.  A “probable link” doesn’t mean that PFOA necessarily causes these diseases. There is no scientific agreement yet about any causal relationships.  The Science Panel’s findings are specifically for the population in West Virginia and Ohio, and aren’t necessarily applicable here. People in the East Metro had PFOA exposures that are around 10 times lower.  The C8 Science Panel is looking at a large number of health outcomes – over 20 diseases. For many of the Probable Link reports released Monday, the studies haven’t been published in scientific journals yet, so we don’t fully understand what the reports are based on. It will take time to review this information. The findings will also be vetted by other scientists.  At this time MDH is not changing our recommendations about medical care – it’s important that everyone gets regular health check‐ups and screenings as recommended by their health care provider.  The good news in MN is that blood levels of PFCs are coming down in East Metro residents, indicating that the efforts to reduce drinking water exposure to PFCs were effective. Frequently Asked Questions  Will MDH test East Metro residents again? o We don’t have any plans to do so at this time as we don’t have funding beyond July 2013. Our plans and funding beyond that point are uncertain. We’ll be consulting our external Advisory Panel for recommendations on whether we should go back to the East Metro community. 33
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Are cancer rates higher in East Metro? o MDH did an analysis in 2007 that showed that cancer rates in the East Metro from 1996 to 2004 are very similar to cancer rates in the rest of the metro area. We are currently working on updating this analysis – it will include testicular and kidney cancer, the two cancers that the C8 Science Panel found had a Probable Link with PFOA. Why didn’t you test kids? o This project was a small pilot project. Our state legislation directed us to measure PFCs in people likely to be highly exposed, so we chose adults who had lived in their homes before 2005. Most exposure to PFCs in drinking water took place before this time. o There are also ethical issues with taking blood samples in children – it is invasive to take a blood sample, and the project didn’t provide a direct health benefit to the child. We also have much more limited information on “background” PFC levels in children that could be used to compare. 34
SectionOverview:BiomonitoringUpdates
These updates report progress in program areas that aren't featured in the current meeting. This section includes status reports on the following projects: 
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Mercury Biomonitoring The Great Lakes Restoration Initiative (GLRI) Biomonitoring National Biomonitoring Initiatives CDC EPHT Biomonitoring Task Force ACTION NEEDED: No action need be taken at this time. Panel members are invited to ask questions and offer comments on the project updates. 35
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BiomonitoringUpdates
Mercury Biomonitoring Update Several public communications of Lake Superior project results were completed in this past quarter. MDH staff presented the findings to Healthy Legacy (NGO groups) and to a professional meeting of APHL laboratory professionals in June. Environmental Health released a press release in early August. A review of data qualifiers with the MDH laboratory staff has resolved questions about the use and reporting of qualified data in aggregate results. A follow‐up biomonitoring project, the Pregnancy and Newborns Exposure Study, a collaboration with UM investigators for The Infant Development and Environment Study (TIDES), was launched in late May. The project will compare mercury levels found in paired newborn cord blood and heel stick spots; the data will aid the interpretation of the blood spot results from the Lake Superior Mercury in Newborns project. The project will also measure lead and cadmium levels in newborn cord blood. Recruitment is going well; as of 8‐23‐2012, 33 women had consented to participate, and specimens had been collected from 14 births. Our goal is to have 75 women recruited by the end of the year (12‐31‐2012). For future work to measure mercury levels in newborns in other parts of the state (outside the Lake Superior region) as recommended by the Advisory Panel, EHTB staff will continue to work with Advisory Panel members to make recommendations to the Steering Committee and Minnesota legislature for the 2013 Report to the Legislature. Submitted by Jean Johnson. Great Lakes Initiative Biomonitoring Update Two full‐time employees have now been hired by Fond du Lac (FDL) to carry out study activities: a study manager and an interviewer/recruiter. MDH is currently training FDL staff on study procedures. In early August, MDH partnered with FDL Information Systems staff to clean and randomize the FDL Human Services Client List, which will serve as the study sampling frame. MDH PHL staff are finalizing contracts for sample analysis with the NY and MI public health laboratories. At the federal level, the Office of Management and Budget is expected imminently to complete the review of the Great Lakes Restoration Initiative (GLRI) biomonitoring package and approve the data collection. Recruitment is anticipated to begin in late August/early September. 37
National Biomonitoring Initiatives Update
Association of Public Health Laboratories (APHL) APHL recently released the “Guidance for Laboratory Biomonitoring Programs.” The document offers guidelines to any state or local public health or environmental laboratory that may become involved in the design and implementation of biomonitoring studies. It outlines the infrastructure and expertise needed to develop laboratory capacity for a biomonitoring program and highlights some of the major considerations chemists should address before beginning a biomonitoring study. The guidance provides a quick reference to specific topics of interest. A companion document, soon to be released by CSTE, will address epidemiological guidance related to biomonitoring. In June, Paul Moyer, MDH PHL, presented the methods and results of Minnesota’s mercury biomonitoring work at the national APHL conference. CDC EPHT Biomonitoring Task Force With the help of MN EPHT graduate student worker, Christy Rosebush, the Task Force is now conducting a survey assessment of available biomonitoring data and project information in the states. The information will be used to identify data gaps and needs across the states, and to develop recommendations. So far, all EPHT grantees (23 states and NYC) have responded, and Christy is working on follow‐up with other respondents. The Task Force has discussed extending the survey to non‐grantee states in the near future. The Task Force has also submitted a work plan to CDC for an additional year of work developing national biomonitoring data for EPHT and providing guidance to states. 38
SectionOverview:TrackingUpdates
These updates report progress in program areas that aren't featured in the current meeting. This section includes status reports on the following projects: 
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Population characteristics Blood lead Obesity and tobacco use COPD maps Reproductive outcomes/birth defects ACTION NEEDED: No action need be taken at this time. Panel members are invited to ask questions and offer comments on the project updates. 39
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TrackingUpdates
Population Characteristics MN EPHT staff are currently evaluating the new topic area of Population Characteristics, which is currently in Phase 3 of the Evaluation Process for new content. New indicators include: people living in poverty, people without health insurance, and median household income. Poverty will be available for children (<18 years) at the county‐level in Minnesota and at the state‐level for children under the age of 5 years. Health insurance data will be available by race/ethnicity (statewide only), and for children (<19 years) at the county‐level in Minnesota. Data sources include the Small Area Income & Poverty Estimates (SAIPE) and Small Area Health Insurance Estimates (SAHIE) Programs from the U.S. Census Bureau. Data are model‐based to provide an annual estimate for every county from 2000‐2010 (income and poverty) and 2005‐2010 (health insurance). Next steps include Phase 3 criteria and Phase 4 implementation of the new data & measures on MNPH Data Access. These new indicators can be used in the future MNPH Data Access mapping tool of side‐by‐side maps, allowing for comparison of childhood lead poisoning data to the percent of children living in poverty by county, for example. Childhood Lead Poisoning Two new years of birth cohort data have been added to Childhood Lead Poisoning data & measures on MNPH Data Access. Through MN EPHT funding provided to the MDH Lead Program in PY3, data entry is now complete through the 2011 test year. By collaborating with Lead Program staff, MN EPHT staff received Blood Lead Information System (BLIS) data required for analysis of the four Tracking measures: number and percent of children tested by birth year; and number and percent of children tested with an Elevated Blood Lead Level (EBLL). The collaboration and funding support has enabled MN EPHT staff to add two additional years of data (2007 & 2008 birth years) despite the absence of an epidemiologist or full data entry team. CDC funding for the MDH Lead Program ends August 31, 2012; it’s possible that the entry of paper reports into the BLIS database will cease due to lack of funding soon after that date. That will severely reduce data quality for three of the four Tracking measures. Without having a denominator for the number of children tested for blood lead, the following measures will no longer be accurate: percent of children tested and percent of children with an EBLL. 41
Behavioral Risk Factors: Obesity and Tobacco The Tracking Program is evaluating the addition of the content area “Behavioral Risk Factors” to the data portal. The tentative launch date is Fall 2012. Tobacco use and overweight/obesity will be included as indicators when the content area is launched; in the future, MN EPHT may add such indicators as physical inactivity, and lack of fruit and vegetable consumption. Public data sets have been obtained from CDC’s Behavioral Risk Factors Surveillance System (BRFSS) website. This population‐based telephone survey collects data on preventive health practices and risk behaviors linked to chronic diseases, injuries, and preventable infectious diseases. Analyses of these data are being completed in collaboration with the Minnesota Center for Health Statistics (MCHS), home of the Minnesota BRFSS. CDC EPHT plans to launch a BRFSS‐based content area in October on the national portal, initially including only a smoking indicator. MN Public Health Data Access will present tobacco use and overweight/obesity as behavioral hazards that can be modified directly by the individual. The data will supplement the information on adverse health outcomes currently displayed on the portal (e.g., heart attacks, cancer, chronic obstructive pulmonary disease (COPD), and asthma). Preliminary analyses indicate that the percent of current smokers in the general adult population of Minnesota declined steadily between 2000 and 2010. This decrease was about in the same proportion for men and women, but was markedly greater in 18 to 24‐year‐olds than in older age groups. In the same time period, levels of overweight remained fairly constant and levels of obesity rose. In 2010, the highest percentage of overweight and obesity was seen in men 45 years of age and older. This content area will track future changes in smoking and overweight/obesity, both informing public health action around behavioral risk factors and measuring its results. Interactive Maps of COPD Data Late summer will see the release of the chronic obstructive pulmonary disease (COPD) interactive mapping portal. Maps of age‐adjusted rates and statistically higher or lower rates compared to the state average will be available in aggregate years of 2005–2007 and 2008–2010. 42
Reproductive & Birth Outcomes The reproductive and birth outcomes data are being updated for the MN Public Health Data Access query. Data are for years 2000‐2010, with linked infant mortality data for years 2000‐2009. Data include:  Prematurity  Term low birth weight  Infant mortality  Sex ratio  Fertility rate Messaging and charts will be updated later this fall. A report on reproductive and birth outcomes is due out later this year. Birth Defects MN EPHT is working with the MDH Birth Defects Program to submit 2006‐2009 birth defects data to CDC during the fall data submission. Although MN EPHT is required to submit birth defects data every year, data will not be shown on the national portal until 5 years of data can be presented in aggregate form. In 2010, the MDH Birth Defects Program transitioned from surveillance in Hennepin and Ramsey counties only to state‐
wide surveillance. Data for year 2010 are being run through quality control and will not be ready for the fall data call. Birth defects pages on MN Public Health Data Access will be updated later this year with new charts and metadata. 43
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SectionOverview:OtherInformation
This section contains documents that may be of interest to panel members. 
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June 2012 Advisory Panel Meeting Summary 2012‐2013 Advisory Panel Meeting dates Advisory Panel Roster Biographical Sketches of Advisory Panel Members Biographical Sketches of Staff Environmental Health Tracking and Biomonitoring Legislation 45
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Summary:June12,2012MeetingoftheEHTBAdvisoryPanel
Panel Attendees: Alan Bender, Bruce Alexander, Geary Olsen, Tom Hawkinson, Cathy Villas‐Horns, Fred Anderson, Greg Pratt, David DeGroote; Jill Heins‐Nesvold & Lisa Yost called in for part of the meeting. Pat McGovern and Cathi Lyman‐Onkka could not attend. Other attendees; Rochelle Spielman, Amy Jacobson (Ramsey County), Paul Moyer, Joanne Bartkus, Joe Zachman, Erik Zabel, Chris Sigstadt, Jim Kelly, Lih‐in Rezania, Heather Kehn, Aggie Leitheiser, David Rindal, Mary Manning, John Soler EHTB Staff: Jean Johnson, Barbara Scott Murdock, Dave Stewart, Chuck Stroebel, Mary Jeanne Levitt, Blair Sevcik, Jeannette Sample, Christina Rosebush, Naomi Shinoda, Paula Lindgren, Debra Lee. Welcome and Introductions Bruce Alexander invited panel members, staff, and members of the audience to introduce themselves, and called the meeting to order. Health Risk Communication in the Age of Social Media John Soler, an epidemiologist for MDH’s Minnesota Cancer Surveillance System (MCSS), presented the case of a citizen’s request for municipal level cancer information that, through social media, burgeoned into a risk communication challenge. The information was soon published in an online newsletter, The Fridley Patch, and the requesters got the attention of Erin Brockovich who planned a meeting with the group. The Facebook page also noted Superfund sites, and pointed out that the city water supply had contained low TCE (trichloroethylene) contamination in the past. [Note: Erin Brockovich visited the community in late June]. The community (Fridley) has an observed cancer rate that is slightly higher than expected (7.6%), John pointed out, but much of the excess is due to lung cancer: 29.7% above the state average, 49% above the state average in females. Anoka appears to have a much higher smoking rate than other metro area counties, according to a recent survey. As a part of Anoka, Fridley probably has high smoking rates, which are the likeliest explanation for the excess of cancers. Communities surrounding Fridley show very similar cancer patterns. Nonetheless, the Facebook page led to the perception that past industrial pollutants are or could be a likely explanation of the excess. In the state as a whole, 48% of the population is expected to have a cancer diagnosis at some point 47
in life. This is higher than for the nation as a whole because of greater longevity in Minnesota and good access to health care, which increases the likelihood of timely diagnosis. Doug Schultz, from MDH’s Communications Office, reviewed some risk communication basics, which involve strategies for dealing with people’s emotional responses to fear, and helping people past their fears with interpretation and understanding. Emphasizing that “we need to see risk as they do,” and then communicate with citizens in ways they can understand. He cited Peter Sandman’s definition (risk = hazard + outrage)9 and argued that if communicators can reduce and manage outrage, people will be attentive and can take part in well informed discussions. He advised asking about people’s concerns, listening, and learning how to express empathy. He quoted Buddy Ferguson’s admonition to “let yourself get beaten up, and listen.” To dealing with social media, he recommended… 1) That MDH establish and maintain credibility and transparency in social media 2) That MDH must use social media to track and gauge public opinion. Social media are immediate, direct, and interactive, he said, so MDH needs to employ them earlier so we can get into the conversation as early as possible. The keys are to… 
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Gather information fast Use dialog and engagement with stakeholders Update information quickly Correct and address errors quickly In the case of the Fridley cancer map, he asked, what could we have done differently? Then added, I’m not sure, but in future, where we see situations in which the data show an increase in some public concern [such as cancer rates], MDH staff can think ahead about how best to address public concerns if and when they arise. In future, MDH should assume that social media will be a likely element in public health issues. Doug advised communicators to identify their audiences and to check with the communications office before replying to a data request to make sure the message is clear. Ideas for MDH’s use of social media include Facebook daily doses, tips via twitter, creating widgets that provide a portal to good information, and links to outside entities, such as the American Public Health Association (APHL), that provide accurate, readable information about cancer or other issues. 9
Geary Olsen notes that Risk = (hazard x exposure) + outrage. Hazard + outrage = perceived risk. 48
Chuck Stroebel reported that the MN Public Health Data Access portal saw a sharp spike in visits and in launching cancer maps during the height of the media coverage of the Fridley cancer scare. Currently, he noted, the portal shows cancer data at the county and state level, but raised a question about how the portal might use local‐level data in future. Note: The MNPH Data Access portal’s cancer page also links to other MDH programs that deal with cancer and to the American Cancer Society’s home page and to its most current report, Cancer Facts & Figures 2012. It also provides a link to the MN Pollution Control Agency, which monitors air and water for cancer‐causing chemicals and other pollutants. Discussion Alan Bender said that, 20 years ago, MDH changed its approach to cancer cluster inquiries by moving quickly to get information and reassuring messages out to the public before the situation had generated much outrage. But social media have shortened the time it takes for the public to become outraged. “Does public health data tracking increase outrage by reducing the time it takes people to get cancer data?” he asked. The time and resources needed to support responses to cluster fears draw these resources away from other public health needs. Bruce Alexander replied that social media are an issue for both MDH and the University of Minnesota. MDH does have to invest resources in this issue, he said. The reality is that social media must be considered, and could be used to engage the community more to solve the problem, rather than creating the problem. Greg Pratt agreed. Misinformation and outrage have been around for a long time, he said, and social media just speed it up. MDH and other agencies have to engage in social media and do their best to get the right story out to the community. Alan said that social media pose less of a problem for MDH per se than for communities, unless MDH can provide a balanced message. Aggie Leitheiser then asked whether social media might provide opportunities for educating the public about preventing health problems. Alan replied that, if a social media response to a community is comprehensive, it could carry preventive messages. It would be difficult and resource‐intensive, but worth exploring. Doug pointed out that one of the important uses of social media is to drive people to link to websites where they can see or hear more about an issue. So as the portal staff put out more data, they might think about what how to respond to potential outrage and try to craft some 140‐character messages to counter misinformation. Greg Pratt noted, however, that the public can be pretty resistant to new information. The public is convinced that industrial pollution causes cancer, he said, and although the MPCA has 49
been explaining for years that non‐point source pollution sources are now more important, people don’t accept it. Geary Olsen summed up the conversation by saying, “Communication is the hardest part of the science.” Tracking Updates Chuck briefly reviewed the written updates, highlighting the NACCHO facilitated discussion. Jean Johnson reviewed the written update about the National Tracking Grantees Workshop, saying that state grantees listed 75 projects that use or link multiple health and environmental datasets. She noted also that the two water quality projects presented and discussed in this Advisory Panel meeting are among those 75 tracking projects. The panel had no questions. Minnesota Water Quality Update Paula Lindgren, research analyst in Environmental Epidemiology, reviewed the current and future status of drinking water quality data that will be available on the MN Public Health Data Access portal (MNPH Data Access). Almost all – 98% – of Minnesota’s community water systems (CWS) provide groundwater; together, they serve 1/3 of the state’s population. The remaining 2% use surface water, are in the Twin Cities, and serve 2/3 of Minnesota’s population. MNPH Data Access currently tracks four chemicals in community water systems: o Arsenic o Nitrate o Two Disinfection By‐Products  Trihalomethanes (THM)  Haloacetic acid (HAA) These chemicals are tested at intervals based on health priorities and on whether the last test was above or below the EPA’s maximum contaminant level (MCL). Testing is more frequent in systems found to have chemical levels above the MCL. CDC has identified six new analytes to feature on their tracking portal and, although these are optional tracking chemicals for EPHT states, Minnesota is considering them. These analytes are… o Atrazine o Radium o Uranium o DEHP (Bis(2‐ethylhexyl)phthalate) o TCE (Trichloroethylene o PCE (Perchloroethylene) 50
Testing in Minnesota has found atrazine in only 5/83 samples; DEHP and uranium have been found rarely. Radium has been found in 10 community water systems and, Paula said, we recommend that the Minnesota portal should include radium data. Paula also showed graphs of various ways to display the data. These ranged from bar graphs showing the percentage of time that CWSs tested below the MCL, to a Minnesota map with dots sized to reflect city or community size and colored to indicate the level of a chemical found in key CWSs. Greg Pratt remarked that he was interested in seeing the total number of CWSs tested/total of all MN CWSs so he could see the percentage of CWSs tested in any one time period. Paula replied that not all CWSs are tested in any one year, so staff at untested CWSs would not like the implication that they weren’t doing their job. More discussion was postponed until after the next presentation. Adverse Child Health Outcomes & Agrichemical Water Contamination in the Midwest Dr. Rachael Jones, assistant professor of occupational and environmental health at the University of Illinois at Chicago (UIC), and doctoral student Kirsten Almberg reviewed this study’s current progress and challenges. The PI for the UIC study is Dr. Leslie Stayner. The primary objectives of the project are to: 1) Enhance the methodology of drinking water contaminant and health data surveillance and linkage; 2) Explore potential associations between birth and childhood health outcomes and exposure to drinking water contaminants, beginning with atrazine and nitrate; 3) Develop partnerships and collaborations with eight Midwestern states: Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, and Wisconsin. Rachael Jones’s talk focused on Minnesota’s CWS drinking water data for nitrate/nitrite and atrazine from years 2000 to 2008. The researchers are also beginning to collect data on private wells. The EPA specifies the MCLs for water contaminants and regulates the CWS monitoring schedule. But, she said, EPA’s regulatory policies require monitoring less frequently than the UIC researchers would like. Atrazine is monitored quarterly in Minnesota, for instance, but if the measured concentration is low or undetectable, monitoring may be repeated only every three years. The sampling is consistent with the Safe Drinking Water Act (SDWA), but too infrequent to detect short‐
term events or easily allow data linkages with health outcomes. In a typical month, only five Minnesota counties have atrazine measurements, compared to 21 counties with nitrate/nitrite measurements. When atrazine is sampled more often [as it is in EPA’s Atrazine Monitoring Program (AMP)], the researchers find more high atrazine 51
levels. This, however, is because the AMP program targets CWS known to have relatively high concentrations. For health data, UIC has focused to date on such outcomes as low birth weight and pre‐
term births, and on statistics such as sex ratio from birth certificates. Data for these are available as monthly or annual rates in each county. The ability to link the drinking water data, typically measured quarterly, annually, or triennially, with birth outcome data, available monthly or yearly, requires both measures to be referenced to a common temporal and spatial scale. The temporal mismatch between these data presents a challenge, because adverse birth outcomes are often associated with exposures during vulnerable time periods in fetal development. Characterizing these exposures requires drinking water quality estimates for each calendar month, and most contaminants of interest are measured far less frequently. To address the problem, UIC researchers decided to apply multiple imputation, a statistical model that uses observed data and other variables to estimate missing data, in this case, drinking water contaminant concentrations in every month in which no measurement was collected. Their first steps were to run the imputation model 5‐10 times with real data, then combine the imputed water quality data, and use a mixed effects regression model to fit a water quality prediction model. Because multiple imputation has not been used for water quality data before, they tested the method using data from EPA’s Atrazine Monitoring Program (AMP). AMP measures atrazine every two weeks in 89 participating CWSs in five of the project states. After running the model with AMP data, the researchers deleted data to create artificial patterns of missing data, so they could compare the results from multiple imputation to those obtained using the true values. They deleted data for four months, eight months, and 10 months. The more data deleted, the higher the uncertainty introduced into regression model coefficients fitted with the imputed data. In these preliminary regression models, the true coefficients fall into the 95th confidence intervals estimated with the imputed data in 100% of instances tested. Still, their initial results suggest that the method may be appropriate for estimating monthly concentrations from quarterly measurements, and quarterly concentrations from annual measurements. The next step is to collect and integrate data from private wells, which people use when they lack CWS or other public water system service. Such data are collected very infrequently. Spatial scales present a different challenge. Databases of drinking water quality indicate only the address of the CWS office, not the site of the treatment plant, and the service 52
areas are unclear. A single CWS may serve part of a town, several cities, or more than one county. And a county often contains from 6 to 15 CWSs. The UIC researchers combine data from multiple CWSs to estimate the potential hazard at the county level. They then calculate a population‐weighted average contaminant concentration for each county in the month, quarter, or year of interest and link this concentration to the health outcome data. Kirsten Almberg then reviewed the strengths and challenges of county‐level Minnesota birth outcome data for 2004‐2008. The outcomes of interest are low birth weight (LBW) and preterm birth (PTB). The LBW rate is 16‐18/1000 and for PTB, is 69‐77/1000. Minnesota not only includes data on birth weight and pre‐term birth on the birth certificate, but also detailed race/ethnicity data, plus data on risk factors such as exposure to tobacco smoke. One challenge is that Minnesota’s data on these outcomes differ from national data; the UIC team uses MN data as the gold standard data. The UIC researchers used Poisson regression models to explore associations between agrichemicals, low birth weight, and prematurity. They used the annual population‐
weighted mean atrazine and nitrate concentrations in each county, and percentage of county land used for agriculture as indicators of environmental quality. Kirsten did an analysis of LBW and agricultural contaminants, and found some association with soybean and corn density, defined as the county’s soy and/or corn acreage divided by the total acreage of the county. She reported a slight protective effect of soybean density on LBW, possibly a result of the rural setting, but after the researchers made adjustments for potential confounders, the data for other effects were neutral. When a random effect was added to account for correlations within counties, the association between atrazine and prematurity disappeared, as did the protective effect of nitrate for low birth weight and prematurity. In the coming year, the group will incorporate the spatial structure of the data into these epidemiological models. Discussion Greg Pratt noted that the group had many non‐detection data for atrazine and asked, did you have a method for handling low detection levels? Rachael replied that the team has been using the ½ LOD (level of detection/2), but is working on other ways to address the issue. We believe that in some places, the atrazine concentrations are truly zero, she said, so we’re trying to find ways to use that fact, so we can employ a more sophisticated method than ½ LOD. Greg agreed, suggesting that they might apply Bayesian methods or try to achieve a lower detection limit in the analyses. Some papers, he said, report effects below the detection levels used in the UIC study. 53
Bruce Alexander asked, in multiple imputation, aren’t the data supposed to be missing at random? But the pattern for atrazine data is not missing at random. Rachael agreed that the data are not missing at random, and said, we’re trying to figure out whether the pattern can void the analysis. The group is working on evaluating the ability to detect a true association. Of the 7000 CWSs in the eight Midwestern states, she explained, only about 350 CWSs had ever detected atrazine between 2000 and 2008. We’re trying to separate out the patterns for systems that have detected atrazine and not add in the other systems that have never detected atrazine. The imputation model may illuminate what’s happening in CWSs with more frequent measurements, and that may inform what happens in systems with missing measurements. David DeGroote asked whether the presence of atrazine had any relationship with time of year. Rachael answered that the team is looking to see whether the pattern is seasonal, particularly in the AMP systems. In general, atrazine is higher in summer, but sometimes, atrazine levels increase in January, probably as a result of hydrologic changes. David asked whether the UIC team had seen a relationship with birth month. Rachael answered that will be part of the project. The researchers are back‐calculating from birth month to time of conception, but that information is not in the project’s models yet, and the group is consulting with experts in maternal and child health to make sure they’re doing the calculations correctly. It’s more difficult to discern seasonal patterns in CWSs, Rachael explained. The data show some differences in season, especially in spring, but it’s hard to get the seasonal patterns because the water sample collection is repeated in the same months every year. It’s possible that any seasonal pattern is confounded by the water sample collection schedule. Geary Olsen asked about the half‐life of atrazine. Rachael replied it depends on what you read. We see that the half‐life of the parent compound seems to vary from days to weeks. The laboratory test measures only the parent compound, not the metabolites. Joe Zachman, from the Minnesota Department of Agriculture, commented that EPA and USGS monitoring for atrazine is linked to surface water, but the UIC project mostly looks at groundwater. So, he said, it appears that you are using surface water to estimate groundwater concentrations, and at least in Minnesota, we don’t see seasonality of atrazine concentrations in groundwater. How do you reconcile using surface water data to look at groundwater? Rachael replied that all the data we presented today used CWS finished water results, but most of the water systems used for atrazine analysis are surface water. The project has not yet tried to incorporate USGS information on the treatment of the surface or groundwater to potential exposures in finished water quality. Joe added that, for soybeans and wheat, greater density indicates lower 54
atrazine levels in those two crops, so he doesn’t think density [of soy and wheat] indicates exposure for birth defects. Kirsten replied, because we don’t have consistent data, if we address one crop, the crop serves as a proxy for a range of pesticides used on that crop – not atrazine specifically. Bruce observed, you say that Minnesota data is of high quality, but that the analyses in other states showed associations, but not in Minnesota. Kirsten replied that the other states publish some confounders at state‐level only, whereas [in Minnesota] we can adjust for confounders like maternal smoking. Maybe, she suggested, the associations we’ve seen in other states reflect the fact that they don’t have data on confounders, so we can’t correct for them. But, she noted, Minnesota also has very low levels of the exposure variables. Tracking Air Quality Impacts Naomi Shinoda reviewed the background, methods, and results of a five‐year EPA STAR grant that explored the feasibility of using local air monitoring data to track public health impacts of PM2.5 in Minnesota’s 7‐county Metropolitan Area (MSP Metro) and in Olmsted County. Airborne fine particulate matter (PM2.5) exposures are associated with health outcomes such as cardiovascular and respiratory disease. In recent years, Minnesota communities have implemented several local and regional air pollution reduction strategies. The Minnesota Metro Emissions Reduction Project (MERP) is a voluntary $1 billion energy project that converted two coal‐fired power plants to natural gas and installed new emissions control equipment on a third plant in the MSP metro during 2007‐2009. The Clean Air Minnesota coalition, partnering with the Minnesota Pollution Control Agency (MPCA), industry, and other members, began implementing voluntary diesel vehicle emission reduction pilot projects in 2005. These have since become a statewide effort and include installing EPA‐verified retrofit technology to reduce diesel emissions from heavy duty public vehicles and school buses. These local air pollution reduction initiatives coincided with federal regulations implemented over the same time period. Since 2008, MDH staff has collaborated with the MPCA and Olmsted Medical Center to develop epidemiologic methods for tracking the public health impacts of changes in PM2.5 concentrations. They used the following data sources in the analyses:  Air quality data o Hourly ambient PM2.5 concentration measurements from MPCA’s PM2.5 continuous monitors (6 monitors in MSP; 1 monitor in Olmsted County). Data were summarized into daily 24‐hour average concentrations. 55

Health data  Hospitalizations for: total respiratory disease, chronic lower respiratory disease (CLRD), asthma, cardiovascular disease  Asthma‐related ED visits  Deaths for: all‐causes, cardiopulmonary disease Staff developed two measures of the exposure‐health association for this project:  Odds ratios (from case‐crossover and time series analyses) o Percent change in hospitalizations/deaths per 10µg/m3 increase in PM2.5  Population attributable fractions (PAFs; only from case‐crossover analyses) o Number or percent of excess hospitalizations/deaths that occurred in the study population that were triggered by observed levels of PM2.5 above a “policy relevant” background concentration (5µg/m3). The analyses for the MSP Metro area found that, over the 7 years, respiratory hospitalization outcomes in the MSP metro were associated with PM2.5, with odds ratios ranging from 1.032 to 1.043 per 10µg/m3 increase in the 3‐day average exposure to PM2.5. These results were consistent with the literature. The PAFs showed change over time in the numbers of respiratory hospitalizations triggered by PM2.5. Total respiratory, chronic lower respiratory disease (CLRD), and asthma hospitalizations attributable to short‐term PM2.5 exposures declined by about 3‐4% after the 2003‐2005 baseline period. The analyses found no consistent associations between ambient PM2.5 levels and the risk of cardiovascular hospitalizations and no consistent associations between ambient PM2.5 levels and the risk of mortality. In Olmsted County, smaller population sizes, plus the fact that only one continuous PM2.5 monitor operated in the county, made it difficult to detect associations of health outcomes with PM2.5. Naomi also pointed out that the project’s results are limited to acute serious health events: hospitalizations. In the entire range of health effects that can be caused by air pollution, hospitalizations are a small portion. Many more people may experience symptoms related to air pollution that may limit their activities and quality of life, and lead to absences at work or school. In this study, the attributable fraction doesn’t capture the long‐term effects of cumulative exposure to PM2.5 or the degree to which PM2.5 contributes to chronic health problems. 56
Lessons learned for expanding this work to other parts of MN  Exposure assignment issues  Consider whether air monitors are available at appropriate geographic locations and how they collect data at temporal scales, such as continuous monitoring vs. 1 data collection/3 days or /6‐days  Consider whether modeled air data are available and usable (hierarchical Bayesian modeled data are available statewide only for years 2001‐2006 thus far)  Population size issues  Consider statistical limitations of conducting analyses in smaller populations  Consider to what extent pooling multiple years of data can help to address those limitations Discussion Questions posed to the panel asked:  If MN EPHT were to continue with this work and build on it to develop an air quality health impact indicator, how should it proceed?  Is the population‐attributable fraction (PAF) a useful tracking measure that the public would understand? The discussion focused on the PAF. Geary Olsen commented that, although the PAF would be a useful tracking measure, in light of the Fridley cancer and social media conversation, how do you think John Q. Public, the average person on social media, would interpret a PAR? Would the public [average citizens who use the MN EPHT portal] perceive it as an individual risk statistic? Aggie Leitheiser thought they would not understand it – the PAF is complicated and does not address the question, “What does it mean for me?” Alan Bender asked, what are we trying to communicate? Regulatory agencies can decide what are good, bad, or indifferent based on data and apply a color code for good, bad, and indifferent. Jean Johnson said that the EPA project wanted grantees to come up with a method to measure whether a policy had an impact on health, and showed measurable progress and accountability. That, Geary pointed out, makes total sense, but is different from question 2. I just don’t know what the public can see and understand. Bruce added, translating the PAR to hospitalizations prevented, and dollars saved per hospitalization would be measures that most people would get. But one issue of 57
concern is that many other factors other than air pollution, such as smoking, contribute to respiratory disease. Air pollution is a small piece of the puzzle, and most hospitalizations for respiratory disease have nothing to do with air pollution. In addition, the case‐crossover method uses a target population of people who end up in the hospital, not the people who are at risk of being in the hospital, but aren't. He noted that it’s unusual to see this population compare so closely to another method (the odds ratio) because usually the results from the two methods are very different. Greg said: the message we want to communicate is one that the public understands: cleaner air is better and healthier. Communicating all the scientific methodology and detail is lost on the public. Alan noted Jean’s point that morbidity and mortality [rates] are related to prevention. But as the cost of reducing emissions rises, we need to translate that cost into a body count to justify the policy. Bruce said, “If you can say that every hospitalization costs $10,000 (and that’s likely too low), then you can get a sense of cost.” He then asked how complete the records on hositalization were in the project – whether the project had included hospitalizations at Mayo or the VA. Naomi said yes for Mayo, but no for the VA hospital. Bruce advised that the communications need to make that clear and explain that the cost estimates are low because you don’t have all hospitalizations. Observing that hospitalizations for asthma are small, as most asthma events are emergency department visits, he added, “This means that this project can’t account for all costs of respiratory diseases.” Naomi noted that the National Tracking program is also working on this issue in terms of Health Impact Assessment, and Jean added that the project looked only at a small piece of the puzzle (acute effects), rather than at the long‐term effects. Mercury Biomonitoring Follow up Projects Update The Pregnancy and Newborn Exposure Study In response to the Advisory Panel’s recommendation in March, MDH is working with Dr. Ruby Nguyen at the University of Minnesota to measure mercury in paired cord blood and newborn blood spots in a small population of newborns. The goal is to test whether mercury concentrations in umbilical cord blood (fetal blood) correlate with mercury levels in newborn blood spots, to speciate cord blood to learn the methyl mercury and inorganic mercury content, and to enable the Public Health Laboratory staff to further refine the laboratory method for measuring mercury in newborn blood spots. 58
Jean Johnson reported the progress made since the March meeting: the MDH staff and the UMN have completed work protocols and work contracts for the study. The UMN IRB approval was granted on May 9 and by the AP meeting date, the MDH IRB had approved the protocol, ruling that the project was exempt. Staff working with Dr. Nguyen will recruit 50 to 100 women who are already participants in The Infant Development and Environment Study (TIDES). The Pregnancy and Newborn Exposure Study will measure mercury (total and speciated), lead, and cadmium in cord blood of newborns and will measure total mercury in the corresponding newborn blood spots. Update: specimen collection began in mid‐June and will end by January 1, 2013. Next Steps Jean told panel members that EHTB staff will be meeting with external and internal stakeholders to gather their advice on long‐term goals for public health tracking and biomonitoring of mercury hazards, exposures, and health effects in Minnesota. Stakeholder advice will be incorporated into recommendations that EHTB staff will present to the Advisory Panel in the fall and into the program’s report to the Minnesota Legislature. These steps follow the Advisory Panel’s recommendation in December, 2011, that MDH should do more work on questions raised by the Lake Superior mercury project “To enable MDH to keep on the table the idea of pursuing more studies as resources appear: 1) To what extent are other populations exposed, and 2) what are the sources of exposure? “ The panel also recommended that MDH should develop specific aims and long term objectives. “The long‐term objectives are to develop other long‐term research agendas to characterize exposure in broader portions of Minnesota—to learn the extent of the source of the problem. The program staff should come back to the panel with specific recommendations.” (Advisory Panel meeting notes, December 13, 2011) Discussion Geary Olsen asked, given the newspaper coverage of the mercury findings, did you get public inquiries from the Arrowhead area? Jim Kelly, from Environmental Health, answered that his division had received some calls and interest, but it was not overwhelming; they had few calls from the general public. Geary said, I find that… interesting, given the magnitude of the association. But Jean suggested that people may see this as a familiar issue and feel that they have control over it. In short, they don’t find it as scary as the Superfund site down the street. She added that a recent EHTB staff presentation to representatives from Healthy Legacy was well received, and 59
that people were receptive and interested in continuing the focus on projects that biomonitored children and pregnant women. Biomonitoring Updates Jean alerted the panel to upcoming reports expected from the C8 (PFOA) study of PFC‐
exposed communities in the Ohio Valley and in Parkersburg, West Virginia [Note: these were all expected in July, but now many are expected in October 2012]. She predicted that MDH would receive many media inquiries. In the September meeting, the EHTB program will ask for the panel’s recommendations about biomonitoring or health follow‐up projects in the East Metro community, and for advice in responding to the C8 “probable link” reports. The two other written updates drew no questions. Legislative Report A new law passed in the 2011‐12 legislative session regulates the collection and testing of newborn blood spots and limits the time for retaining specimens and test results. Aggie Leitheiser explained that, in addition, the legislature provided a one‐year authorization for MDH programs to continue while a review of statutory authority is completed. MDH must submit legislative proposals to assure explicit authority is in place to collect, use, store, and disseminate individually identifiable data that may have a genetic component. Because the statute definitions and the Minnesota Supreme Court interpretation of genetic information are so broad, this includes any form of health data. The statute may affect other state agencies and private providers, including UMN or blood/data collected in connection with a drunken driving incident. New Business Bruce Alexander asked whether panel members had suggestions for new business. Hearing none, he asked for a motion to adjourn the meeting. The meeting was adjourned at 3:52 PM. 60
2012‐2013MeetingSchedule
2012AdvisoryPanelMeetings
Tuesday, Sept. 11, 1 – 4 pm The meeting will take place in: The Red River Room Snelling Office Park 1645 Energy Park Drive St. Paul, Minnesota Tuesday, Dec. 11 1‐4 pm 2013AdvisoryPanelMeetings
Tuesday, Mar 12 1–4 pm Tuesday, Jun 11 1–4 pm All meetings for 2013 will take place at The Red River Room Snelling Office Park 1645 Energy Park Drive St. Paul 61
EnvironmentalHealthTrackingandBiomonitoring
AdvisoryPanelRoster
AsofAugust2012
Bruce Alexander, PhD University of Minnesota School of Public Health Environmental Health Sciences Division MMC 807 Mayo 420 Delaware Street SE Minneapolis, Minnesota 55455 612‐625‐7934 [email protected] At‐large representative Fred Anderson, MPH Washington County Department of Public Health and Environment 14949 62nd St N Stillwater MN 55082 651‐430‐6655 [email protected] At‐large representative Alan Bender, DVM, PhD Minnesota Department of Health Health Promotion and Chronic Disease Division 85 East 7th Place PO Box 64882 Saint Paul, MN 55164‐0882 651‐201‐5882 [email protected] MDH appointee David DeGroote, PhD St. Cloud State University 740 4th Street South St. Cloud, MN 56301 320‐308‐2192 [email protected] Minnesota House of Representatives appointee Thomas Hawkinson, MS, CIH, CSP Toro Company 8111 Lyndale Avenue S Bloomington, MN 55420 [email protected] Statewide business org representative Jill Heins Nesvold, MS American Lung Association of Minnesota 490 Concordia Avenue St. Paul, Minnesota 55103 651‐223‐9578 [email protected] Nongovernmental organization representative Pat McGovern, PhD, MPH University of Minnesota School of Public Health Environmental Health Sciences Division MMC Mayo 807 420 Delaware St SE Minneapolis MN 55455 612‐625‐7429 [email protected] University of Minnesota representative 62
Geary Olsen, DVM, PhD 3M Medical Department Corporate Occupational Medicine MS 220‐6W‐08 St. Paul, Minnesota 55144‐1000 651‐737‐8569 [email protected] Statewide business organization representative Gregory Pratt, PhD Minnesota Pollution Control Agency Environmental Analysis and Outcomes Division 520 Lafayette Road St. Paul, MN 55155‐4194 651‐757‐2655 [email protected] MPCA appointee Cathy Villas‐Horns, MS, PG Minnesota Department of Agriculture Pesticide and Fertilizer Management Division 625 Robert Street North St. Paul, Minnesota 55155‐2538 651‐201‐6291 cathy.villas‐[email protected] MDA appointee Lisa Yost, MPH, DABT ENVIRON International Corporation 333 West Wacker Drive, Suite 2700 Chicago, IL 60606 Local office 886 Osceola Avenue St. Paul, Minnesota 55105 Phone: 651‐225‐1592 Cell: 651‐470‐9284 [email protected] At‐large representative Vacant Nongovernmental organization representative Vacant Minnesota Senate appointee 63
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BiographicalSketchesofAdvisoryPanelMembers
Bruce H. Alexander is an Associate Professor in the Division of Environmental Health Sciences at the University of Minnesota’s School of Public Health. Dr. Alexander is an environmental and occupational epidemiologist with expertise in cancer, reproductive health, respiratory disease, injury, exposure assessment, and use of biological markers in public health applications. Fred Anderson is an epidemiologist at the Washington County Department of Public Health and Environment and has over 30 years of public health experience. .He holds a Master of Public Health (MPH) in environmental and infectious disease epidemiology from the University of Minnesota and is a registered environmental health specialist. For over 20 years, he has led county‐wide disease surveillance and intervention programs, including numerous multidisciplinary epidemiologic investigations. Alan Bender is the Section Chief of Chronic Disease and Environmental Epidemiology at the Minnesota Department of Health. He holds a Doctor of Veterinary Medicine degree from the University of Minnesota and a PhD in Epidemiology from Ohio State University. His work has focused on developing statewide surveillance systems, including cancer and occupational health, and exploring the links between occupational and environmental exposures and chronic disease and mortality. David DeGroote is Dean of the College of Science and Engineering and Professor of Biological Sciences at St. Cloud State University. He has been at St. Cloud State University since 1985, initially as an Assistant Professor in Biological Sciences. He served as Department Chair from 1996 to 2003 before moving to the Dean’s Office. Most recently he had focused on providing up‐to‐date academic programming and facilities that serve the needs of Minnesota employers in the health sciences, engineering, computing, biosciences, and STEM education. Tom Hawkinson is the Corporate Environmental, Health, and Safety Manager for the Toro Company in Bloomington, MN. He completed his MS in Public Health at the University of Minnesota, with a specialization in industrial hygiene. He is certified in the comprehensive practice of industrial hygiene and a certified safety professional. He has worked in EHS management at a number of Twin Cities based companies, conducting industrial hygiene investigations of workplace contaminants and done environmental investigations of subsurface contamination both in the United States and Europe. He has taught statistics and mathematics at both graduate and undergraduate levels as an adjunct, and is on the faculty at the Midwest Center for Occupational Health and Safety, a NIOSH‐Sponsored Education and Research Center in the School of Public Health, University of Minnesota. 65
Jill Heins Nesvold serves as the Director of the Respiratory Health Division for the American Lung Association in Iowa, Minnesota, North Dakota, and South Dakota. Her responsibilities include program oversight and evaluation related to asthma, chronic obstructive lung disease (COPD), lung cancer, and influenza. Jill holds a master’s degree in health management and a short‐course master’s of business administration. Jill has published extensively in a variety of public health areas. Pat McGovern is a Professor in the Division of Environmental Health Sciences at the University of Minnesota’s School of Public Health. Dr. McGovern is a health services researcher and nurse with expertise in environmental and occupational health policy and health outcomes research. She serves as the Principal Investigator for the National Children’s Study (NCS) Center serving Ramsey County, one of 105 study locations nationwide. The NCS is the largest, long‐term study of children’s health and development in the US and the assessment of environmental exposures will include data collection from surveys, biological specimens and environmental samples. Geary Olsen is a corporate scientist in the Medical Department of the 3M Company. He obtained a Doctor of Veterinary Medicine (DVM) degree from the University of Illinois and a Master of Public Health (MPH) in veterinary public health and PhD in epidemiology from the University of Minnesota. For 27 years he has been engaged in a variety of occupational and environmental epidemiology research studies while employed at Dow Chemical and, since 1995, at 3M. His primary research activities at 3M have involved the epidemiology, biomonitoring (occupational and general population), and pharmacokinetics of perfluorochemicals. Greg Pratt is a research scientist at the Minnesota Pollution Control Agency. He holds a Ph.D. from the University of Minnesota in Plant Physiology where he worked on the effects of air pollution on vegetation. Since 1984 he has worked for the MPCA on a wide variety of issues including acid deposition, stratospheric ozone depletion, climate change, atmospheric fate and dispersion of air pollution, monitoring and occurrence of air pollution, statewide modeling of air pollution risks, and personal exposure to air pollution. He is presently cooperating with the Minnesota Department of Health on a research project on the Development of Environmental Health Outcome Indicators: Air Quality Improvements and Community Health Impacts. 66
Cathy Villas Horns is the Hydrologist Supervisor of the Incident Response Unit (IRU) within the Pesticide and Fertilizer Management Unit of the Minnesota Department of Agriculture. Cathy holds a Master of Science in Geology from the University of Delaware and a Bachelor of Science in Geology from Carleton College and is a licensed Professional Geologist in MN. The IRU oversees or conducts the investigation and cleanup of point source releases of agricultural chemicals (fertilizers and pesticides including herbicides, insecticides, fungicides, etc. as well as wood treatment chemicals) through several different programs. Cathy has worked on complex sites with Minnesota Department of Health and MPCA staff, and continues to work with interagency committees on contaminant issues. She previously worked as a senior hydrogeologist within the IRU, and as a hydrogeologist at the Minnesota Pollution Control Agency and an environmental consulting firm. Lisa Yost is a Principal Consultant at ENVIRON, an international consulting firm. She is in their Health Sciences Group, and is based in Saint Paul, Minnesota. Ms. Yost completed her training at the University of Michigan’s School of Public Health and is a board‐certified toxicologist with expertise in evaluating human health risks associated with substances in soil, water, and the food chain. She has conducted or supervised risk assessments under CERCLA, RCRA, or state‐led regulatory contexts involving a wide range of chemicals and exposure situations. Her areas of specialization include exposure and risk assessment, risk communication, and the toxicology of such chemicals as PCDDs and PCDFs, PCBs, pentachlorophenol (PCP), trichloroethylene (TCE), mercury, and arsenic. Ms. Yost is a recognized expert in risk assessment and has collaborated in original research on exposure issues, including background dietary intake of inorganic arsenic. She is currently assisting in a number of projects, including a complex multi‐pathway risk assessment for PDDD/Fs that will integrate extensive biomonitoring data collected by the University of Michigan. Ms. Yost is also an Adjunct Instructor at the University of Minnesota’s School of Public Health. 67
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StaffBiosketches
Wendy Brunner, PhD, serves as surveillance epidemiologist for the MDH Asthma Program since 2002, and joined the MN EPHT program on a part‐time basis in fall 2009. Previously, she worked on occupational respiratory disease studies for MDH. She has a master’s degree in Science and Technology Studies from Rensselaer Polytechnic Institute and a master’s degree in Environmental and Occupational Health from the University of Minnesota. She is currently a doctoral student in the Division of Epidemiology and Community Health at the University of Minnesota. Tess Gallaher, MPH, is an Epidemiology Fellow from the Council of State and Territorial Epidemiologists (CSTE), who joined the Environmental Epidemiology unit staff in August 2012 for a 2 year fellowship. Tess is working on several projects with EPHT, including climate change (heat‐related morbidity and mortality) and birth defects surveillance. Tess completed her MPH in Occupational Environmental Epidemiology from the University of Michigan in April, 2012. Eric Hanson, MS, is an Information Technology Specialist with the Environmental Public Health Tracking program. His work is focused in Geographic Information Systems (GIS), application development, cartography, data visualization, data management and providing GIS technical assistance. He has a Master’s degree in Geographic Information Systems (GIS) and Masters Minor in Public Health from the University of Minnesota. Jean Johnson, MS, PhD, is Director/Principal Investigator for Minnesota’s Environmental Public Health Tracking and Biomonitoring Program and is the supervisor for the Environmental Epidemiology Unit at MDH. Dr. Johnson received her Ph.D. and M.S. degrees from the University of Minnesota’s School of Public Health in Environmental Health and has over 25 years of experience working with the state of Minnesota in the environmental health field. As an environmental epidemiologist at MDH, her work has focused on special investigations of population exposure and health, including studies of chronic diseases related to air pollution and asbestos exposure, and exposure to drinking water contaminants. She is currently the Principal Investigator on an EPA grant to develop methods for measuring the public health impacts of population exposure to particulate matter (PM) in air. She is also an adjunct faculty member at the University of Minnesota School of Public Health. Mary Jeanne Levitt, MBC, is the communications coordinator with the Minnesota Environmental Public Health Tracking program. She has a Master’s in Business Communications and has worked for over 20 years in both the public and non‐profit sector in project management of research and training grants, communications and marketing strategies, focus groups and evaluations of educational needs of public health professionals. She serves on 3 institutional review boards which specialize in academic research, oncology research, and overall clinical research. 69
Paula Lindgren, MS, received her Master of Science degree in Biostatistics from the University of Minnesota. She works for the Minnesota Department of Health as a biostatistician, and provides statistical and technical support to the MN EPHT and Biomonitoring programs for data reports, publications, web‐based portal dissemination and presentations in the Chronic Disease and Environmental Epidemiology section. Ms. Lindgren has also received training in the area of GIS for chronic disease mapping and analysis. In addition to her work for MN EPHT, she works for various programs within Chronic Disease and Environmental Epidemiology including the Asthma program, Center for Occupational Health and Safety, Minnesota Cancer Surveillance System, and Cancer Control section. Barbara Scott Murdock, MA, MPH, is the Program Planner for the state Environmental Public Health Tracking and Biomonitoring (EHTB) program, responsible for leading strategic planning and communications with stakeholders and the EHTB Advisory Panel. A biologist and public health professional by education, she has over 30 years of experience in writing and editing professional publications. Recently a grants coordinator/writer for social science faculty at the University of Minnesota, she also served as the biomonitoring project manager at the Minnesota Department of Health (2001‐2003); senior research fellow in the Center for Environment & Health Policy, UMN School of Public Health (1995‐2001); director of water and health programs at the Freshwater Foundation (1991‐1992); and founding editor of the Health & Environment Digest, a peer‐reviewed publication for environmental health and management professionals in the US and Canada (1986‐1992). She holds a BS in biochemistry from the University of Chicago, an MA in zoology from Duke University, and an MPH from the University of Minnesota. Jessica Nelson, PhD, is an epidemiologist with the Minnesota Environmental Public Health Tracking and Biomonitoring Program, working primarily on design, coordination, and analysis of biomonitoring projects. Jessica received her PhD and MPH in Environmental Health from the Boston University School of Public Health where her research involved the epidemiologic analysis of biomonitoring data on perfluorochemicals. Jessica was the coordinator of the Boston Consensus Conference on Biomonitoring, a project that gathered input and recommendations on the practice and uses of biomonitoring from a group of Boston‐area lay people. Christy Rosebush is a Student Worker Paraprofessional Sr. and has worked with the MDH EPHT program since January 2012. Her work has included monitoring the epidemiological literature on PFCs, assisting in biomonitoring data analyses, and developing new data and measures for tracking behavioral health risk factors. Christy is currently in her second year of a master’s degree program in epidemiology and health disparities at the University of Minnesota’s School of Public Health. 70
Jeannette M. Sample, MPH, is an epidemiologist with the Minnesota Environmental Public Health Tracking program at the Minnesota Department of Health, working primarily with the collection and statistical analysis of public health surveillance data for EPHT. She also works on research collaborations with academic partners relating to reproductive outcomes and birth defects. Prior to joining EPHT, she was a CSTE/CDC Applied Epidemiology Fellow with the MDH Birth Defect Information System. Jeannette received her Master’s degree in epidemiology and biostatistics from The George Washington University in Washington, DC. Blair Sevcik, MPH, is an epidemiologist with the Minnesota Environmental Public Health Tracking (EPHT) program at the Minnesota Department of Health, where she works on the collection and statistical analysis of public health surveillance data for EPHT, focusing on cancer, blood lead, and population characteristics. Prior to joining EPHT in January 2009, she was a student worker with the MDH Asthma Program. She received her Master of Public Health degree in epidemiology from University of Minnesota School of Public Health. Chuck Stroebel, MSPH, is the MN EPHT Program Manager. He provides day‐to‐day direction for program activities, including: 1) development and implementation of the state network, 2) development and transport of NCDMs and metadata for the national network, and 3) collaboration and communication with key EPHT partners and stakeholders. Chuck received a Master’s of Public Health in Environmental Health Sciences from the University of North Carolina (Chapel Hill). He has over 15 years of expertise in environmental health, including areas of air quality, pesticides, climate change, risk assessment, and toxicology. Chuck also played a key role in early initiatives to build tracking capacity at the Minnesota Department of Health. Currently, he is a member of the IBIS Steering Committee (state network), the MDH ASTHO Grant Steering Committee (climate change), and the Northland Society of Toxicology. He also serves on the MN EPHT Technical and Communications Teams. Allan N. Williams, MPH, PhD, is an environmental and occupational epidemiologist in the Chronic Disease and Environmental Epidemiology Section at the Minnesota Department of Health. He is the supervisor for the MDH Center for Occupational Health and Safety. For over 25 years, he has worked on issues relating to environmental and occupational cancer, cancer clusters, work‐related respiratory diseases, and the surveillance and prevention of work‐related injuries among adolescents. He has served as the PI on two NIOSH R01 grants, as a co‐investigator on four other federally‐funded studies in environmental or occupational health, and is an adjunct faculty member in the University of Minnesota’s School of Public Health. He received an MA in Biology from Indiana University, an MPH in Environmental Health and Epidemiology from the University of Minnesota, and a PhD in Environmental and Occupational Health from the University of Minnesota 71
EnvironmentalHealthTrackingandBiomonitoringStatute
$1,000,000 each year is for environmental
health tracking and biomonitoring. Of this
amount, $900,000 each year is for transfer to
the Minnesota Department of Health. The
base appropriation for this program for fiscal
year 2010 and later is $500,000.
144.995 DEFINITIONS;
ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING.
(a) For purposes of sections 144.995 to
144.998, the terms in this section have the
meanings given.
(b) "Advisory panel" means the
Environmental Health Tracking and
Biomonitoring Advisory Panel established
under section 144.998.
(c) "Biomonitoring" means the process by
which chemicals and their metabolites are
identified and measured within a
biospecimen.
(d) "Biospecimen" means a sample of
human fluid, serum, or tissue that is
reasonably available as a medium to
measure the presence and concentration of
chemicals or their metabolites in a human
body.
(e) "Commissioner" means the
commissioner of the Department of Health.
(f) "Community" means geographically or
nongeographically based populations that
may participate in the biomonitoring
program. A "nongeographical community"
includes, but is not limited to, populations
that may share a common chemical exposure
through similar occupations, populations
experiencing a common health outcome that
may be linked to chemical exposures,
populations that may experience similar
chemical exposures because of comparable
consumption, lifestyle, product use, and
subpopulations that share ethnicity, age, or
gender.
(g) "Department" means the Department
of Health.
(h) "Designated chemicals" means those
chemicals that are known to, or strongly
suspected of, adversely impacting human
health or development, based upon
scientific, peer-reviewed animal, human, or
in vitro studies, and baseline human
exposure data, and consists of chemical
families or metabolites that are included in
the federal Centers for Disease Control and
Prevention studies that are known
collectively as the National Reports on
Human Exposure to Environmental
Chemicals Program and any substances
specified by the commissioner after
receiving recommendations under section
144.998, subdivision 3, clause (6).
(i) "Environmental hazard" means a
chemical or other substance for which
scientific, peer-reviewed studies of humans,
animals, or cells have demonstrated that the
chemical is known or reasonably anticipated
to adversely impact human health.
(j) "Environmental health tracking" means
collection, integration, analysis, and
dissemination of data on human exposures
to chemicals in the environment and on
diseases potentially caused or aggravated by
those chemicals.
144.996 ENVIRONMENTAL HEALTH
TRACKING; BIOMONITORING.
Subdivision 1. Environmental health
tracking. In cooperation with the
commissioner of the Pollution Control
Agency, the commissioner shall establish an
environmental health tracking program to:
(1) coordinate data collection with the
Pollution Control Agency, Department of
Agriculture, University of Minnesota, and
any other relevant state agency and work to
promote the sharing of and access to health
and environmental databases to develop an
environmental health tracking system for
Minnesota, consistent with applicable data
practices laws;
(2) facilitate the dissemination of
aggregate public health tracking data to the
public and researchers in accessible format;
(3) develop a strategic plan that includes a
mission statement, the identification of core
priorities for research and epidemiologic
surveillance, and the identification of
internal and external stakeholders, and a
work plan describing future program
development and addressing issues having
to do with compatibility with the Centers for
Disease Control and Prevention's National
Environmental Public Health Tracking
Program;
(4) develop written data sharing
agreements as needed with the Pollution
Control Agency, Department of Agriculture,
and other relevant state agencies and
organizations, and develop additional
procedures as needed to protect individual
privacy;
(5) organize, analyze, and interpret
available data, in order to:
(i) characterize statewide and localized
trends and geographic patterns of
population-based measures of chronic
diseases including, but not limited to,
cancer, respiratory diseases, reproductive
problems, birth defects, neurologic diseases,
and developmental disorders;
(ii) characterize statewide and localized
trends and geographic patterns in the
occurrence of environmental hazards and
exposures;
(iii) assess the feasibility of integrating
disease rate data with indicators of exposure
to the selected environmental hazards such
as biomonitoring data, and other health and
environmental data;
(iv) incorporate newly collected and
existing health tracking and biomonitoring
data into efforts to identify communities
with elevated rates of chronic disease,
higher likelihood of exposure to
environmental hazards, or both;
(v) analyze occurrence of environmental
hazards, exposures, and diseases with
relation to socioeconomic status, race, and
ethnicity;
(vi) develop and implement targeted plans
to conduct more intensive health tracking
and biomonitoring among communities; and
(vii) work with the Pollution Control
Agency, the Department of Agriculture, and
other relevant state agency personnel and
organizations to develop, implement, and
evaluate preventive measures to reduce
elevated rates of diseases and exposures
identified through activities performed under
sections 144.995 to 144.998; and
(6) submit a biennial report to the chairs
and ranking members of the committees
with jurisdiction over environment and
health by January 15, beginning January 15,
2009, on the status of environmental health
tracking activities and related research
programs, with recommendations for a
comprehensive environmental public health
tracking program.
Subd. 2. Biomonitoring. The
commissioner shall:
(1) conduct biomonitoring of
communities on a voluntary basis by
collecting and analyzing biospecimens, as
appropriate, to assess environmental
exposures to designated chemicals;
(2) conduct biomonitoring of pregnant
women and minors on a voluntary basis,
when scientifically appropriate;
(3) communicate findings to the public,
and plan ensuing stages of biomonitoring
and disease tracking work to further develop
and refine the integrated analysis;
(4) share analytical results with the
advisory panel and work with the panel to
interpret results, communicate findings to
the public, and plan ensuing stages of
biomonitoring work; and
(5) submit a biennial report to the chairs
and ranking members of the committees
with jurisdiction over environment and
health by January 15, beginning January 15,
2009, on the status of the biomonitoring
program and any recommendations for
improvement.
Subd. 3. Health data. Data collected
under the biomonitoring program are health
data under section 13.3805.
144.997 BIOMONITORING PILOT
PROGRAM.
Subdivision 1. Pilot program. With
advice from the advisory panel, and after the
program guidelines in subdivision 4 are
developed, the commissioner shall
implement a biomonitoring pilot program.
The program shall collect one biospecimen
from each of the voluntary participants. The
73
biospecimen selected must be the
biospecimen that most accurately represents
body concentration of the chemical of
interest. Each biospecimen from the
voluntary participants must be analyzed for
one type or class of related chemicals. The
commissioner shall determine the chemical
or class of chemicals to which community
members were most likely exposed. The
program shall collect and assess
biospecimens in accordance with the
following:
(1) 30 voluntary participants from each of
three communities that the commissioner
identifies as likely to have been exposed to a
designated chemical;
(2) 100 voluntary participants from each
of two communities:
(i) that the commissioner identifies as
likely to have been exposed to arsenic; and
(ii) that the commissioner identifies as
likely to have been exposed to mercury; and
(3) 100 voluntary participants from each
of two communities that the commissioner
identifies as likely to have been exposed to
perfluorinated chemicals, including
perfluorobutanoic acid.
Subd. 2. Base program. (a) By January
15, 2008, the commissioner shall submit a
report on the results of the biomonitoring
pilot program to the chairs and ranking
members of the committees with jurisdiction
over health and environment.
(b) Following the conclusion of the pilot
program, the commissioner shall:
(1) work with the advisory panel to assess
the usefulness of continuing biomonitoring
among members of communities assessed
during the pilot program and to identify
other communities and other designated
chemicals to be assessed via biomonitoring;
(2) work with the advisory panel to assess
the pilot program, including but not limited
to the validity and accuracy of the analytical
measurements and adequacy of the
guidelines and protocols;
(3) communicate the results of the pilot
program to the public; and
(4) after consideration of the findings and
recommendations in clauses (1) and (2), and
within the appropriations available, develop
and implement a base program.
Subd. 3. Participation. (a) Participation
in the biomonitoring program by providing
biospecimens is voluntary and requires
written, informed consent. Minors may
participate in the program if a written
consent is signed by the minor's parent or
legal guardian. The written consent must
include the information required to be
provided under this subdivision to all
voluntary participants.
(b) All participants shall be evaluated for
the presence of the designated chemical of
interest as a component of the biomonitoring
process. Participants shall be provided with
information and fact sheets about the
program's activities and its findings.
Individual participants shall, if requested,
receive their complete results. Any results
provided to participants shall be subject to
the Department of Health Institutional
Review Board protocols and guidelines.
When either physiological or chemical data
obtained from a participant indicate a
significant known health risk, program staff
experienced in communicating
biomonitoring results shall consult with the
individual and recommend follow-up steps,
as appropriate. Program administrators shall
receive training in administering the
program in an ethical, culturally sensitive,
participatory, and community-based manner.
Subd. 4. Program guidelines. (a) The
commissioner, in consultation with the
advisory panel, shall develop:
(1) protocols or program guidelines that
address the science and practice of
biomonitoring to be utilized and procedures
for changing those protocols to incorporate
new and more accurate or efficient
technologies as they become available. The
commissioner and the advisory panel shall
be guided by protocols and guidelines
developed by the Centers for Disease
Control and Prevention and the National
Biomonitoring Program;
(2) guidelines for ensuring the privacy of
information; informed consent; follow-up
counseling and support; and communicating
findings to participants, communities, and
the general public. The informed consent
74
used for the program must meet the
informed consent protocols developed by
the National Institutes of Health;
(3) educational and outreach materials
that are culturally appropriate for
dissemination to program participants and
communities. Priority shall be given to the
development of materials specifically
designed to ensure that parents are informed
about all of the benefits of breastfeeding so
that the program does not result in an
unjustified fear of toxins in breast milk,
which might inadvertently lead parents to
avoid breastfeeding. The materials shall
communicate relevant scientific findings;
data on the accumulation of pollutants to
community health; and the required
responses by local, state, and other
governmental entities in regulating toxicant
exposures;
(4) a training program that is culturally
sensitive specifically for health care
providers, health educators, and other
program administrators;
(5) a designation process for state and
private laboratories that are qualified to
analyze biospecimens and report the
findings; and
(6) a method for informing affected
communities and local governments
representing those communities concerning
biomonitoring activities and for receiving
comments from citizens concerning those
activities.
(b) The commissioner may enter into
contractual agreements with health clinics,
community-based organizations, or experts
in a particular field to perform any of the
activities described under this section.
144.998 ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING
ADVISORY PANEL.
Subdivision 1. Creation. The
commissioner shall establish the
Environmental Health Tracking and
Biomonitoring Advisory Panel. The
commissioner shall appoint, from the panel's
membership, a chair. The panel shall meet
as often as it deems necessary but, at a
minimum, on a quarterly basis. Members of
the panel shall serve without compensation
but shall be reimbursed for travel and other
necessary expenses incurred through
performance of their duties. Members
appointed by the commissioner are
appointed for a three-year term and may be
reappointed. Legislative appointees serve at
the pleasure of the appointing authority.
Subd. 2. Members. (a) The commissioner
shall appoint eight members, none of whom
may be lobbyists registered under chapter
10A, who have backgrounds or training in
designing, implementing, and interpreting
health tracking and biomonitoring studies or
in related fields of science, including
epidemiology, biostatistics, environmental
health, laboratory sciences, occupational
health, industrial hygiene, toxicology, and
public health, including:
(1) at least two scientists representative of
each of the following:
(i) nongovernmental organizations with a
focus on environmental health,
environmental justice, children's health, or
on specific chronic diseases; and
(ii) statewide business organizations; and
(2) at least one scientist who is a
representative of the University of
Minnesota.
(b) Two citizen panel members meeting
the scientific qualifications in paragraph (a)
shall be appointed, one by the speaker of the
house and one by the senate majority leader.
(c) In addition, one representative each
shall be appointed by the commissioners of
the Pollution Control Agency and the
Department of Agriculture, and by the
commissioner of health to represent the
department's Health Promotion and Chronic
Disease Division.
Subd. 3. Duties. The advisory panel shall
make recommendations to the commissioner
and the legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are
based on sound science and practice, and
that will advance the state of public health in
Minnesota;
(3) specific chronic diseases to study
under the environmental health tracking
system;
75
(4) specific environmental hazard
exposures to study under the environmental
health tracking system, with the agreement
of at least nine of the advisory panel
members;
(5) specific communities and geographic
areas on which to focus environmental
health tracking and biomonitoring efforts;
(6) specific chemicals to study under the
biomonitoring program, with the agreement
of at least nine of the advisory panel
members; in making these
recommendations, the panel may consider
the following criteria:
(i) the degree of potential exposure to the
public or specific subgroups, including, but
not limited to, occupational;
(ii) the likelihood of a chemical being a
carcinogen or toxicant based on peerreviewed health data, the chemical structure,
or the toxicology of chemically related
compounds;
(iii) the limits of laboratory detection for
the chemical, including the ability to detect
the chemical at low enough levels that could
be expected in the general population;
(iv) exposure or potential exposure to the
public or specific subgroups;
(v) the known or suspected health effects
resulting from the same level of exposure
based on peer-reviewed scientific studies;
(vi) the need to assess the efficacy of
public health actions to reduce exposure to a
chemical;
(vii) the availability of a biomonitoring
analytical method with adequate accuracy,
precision, sensitivity, specificity, and speed;
(viii) the availability of adequate
biospecimen samples; or
(ix) other criteria that the panel may agree
to; and
(7) other aspects of the design,
implementation, and evaluation of the
environmental health tracking and
biomonitoring system, including, but not
limited to:
(i) identifying possible community
partners and sources of additional public or
private funding;
(ii) developing outreach and educational
methods and materials; and
(iii) disseminating environmental health
tracking and biomonitoring findings to the
public.
Subd. 4. Liability. No member of the
panel shall be held civilly or criminally
liable for an act or omission by that person if
the act or omission was in good faith and
within the scope of the member's
responsibilities under sections 144.995 to
144.998.
INFORMATION SHARING.
On or before August 1, 2007, the
commissioner of health, the Pollution
Control Agency, and the University of
Minnesota are requested to jointly develop
and sign a memorandum of understanding
declaring their intent to share new and
existing environmental hazard, exposure,
and health outcome data, within applicable
data privacy laws, and to cooperate and
communicate effectively to ensure sufficient
clarity and understanding of the data by
divisions and offices within both
departments. The signed memorandum of
understanding shall be reported to the chairs
and ranking members of the senate and
house of representatives committees having
jurisdiction over judiciary, environment, and
health and human services.
Effective date: July 1, 2007
This document contains Minnesota Statutes,
sections 144.995 to 144.998, as these
sections were adopted in Minnesota Session
Laws 2007, chapter 57, article 1, sections
143 to 146. The appropriation related to
these statutes is in chapter 57, article 1,
section 3, subdivision 4. The paragraph
about information sharing is in chapter 57,
article 1, section 169. The following is a link
to chapter 57:
http://ros.leg.mn/bin/getpub.php?type=law&
year=2007&sn=0&num=57
76
LawsofMinnesota2011First
SpecialSessionChapter2.
Bill for an Act. SF 3, Sec.3. Pollution
Control Agency, Subd.4 Land
Cite as: Laws of Minnesota 2011 First
Special Session Chapter 2.
Environmental 6,916,000
6,916,000
Remediation 10,496,000 10,496,000
General
268,000 268,000
All money for environmental response,
compensation, and compliance in the
remediation fund not otherwise appropriated
is appropriated to the commissioners of the
Pollution Control Agency and agriculture
for purposes of Minnesota Statutes, section
115B.20, subdivision 2, clauses (1), (2), (3),
(6), and (7). At the beginning of each fiscal
year, the two commissioners shall jointly
submit an annual spending plan to the
commissioner of management and budget
that maximizes the utilization of resources
and appropriately allocates the money
between the two departments. This
appropriation is available until June 30,
2013. $3,616,000 the first year and
$3,616,000 the second year are from the
petroleum tank fund to be transferred to the
remediation fund for purposes of the
leaking underground storage
tank program to protect the land.
$252,000 the first year and $252,000 the
second year are from the remediation fund
for transfer to the commissioner of health
for private water supply monitoring and
health assessment costs in areas
contaminated by unpermitted mixed
municipal solid waste disposal facilities and
drinking water advisories and public
information activities for areas contaminated
by hazardous releases.
$268,000 the first year and $268,000 the
second year are for transfer to the
Department of Health to complete the
environmental health tracking and
biomonitoring analysis related to
perfluorochemicals and mercury
monitoring in Lake Superior and
disseminate the results. This is a onetime
appropriation.